scholarly journals Towards a new model for producing evidence-based guidelines: a qualitative study of current approaches and opportunities for innovation among Australian guideline developers

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 956
Author(s):  
Steve McDonald ◽  
Julian H. Elliott ◽  
Sally Green ◽  
Tari Turner
Keyword(s):  
Systematic Reviews ◽  
New Technologies ◽  
Research Output ◽  
Guideline Development ◽  
Evidence Based ◽  
Structured Interviews ◽  
Australian Guideline ◽  
Horizon Scanning ◽  
New Guidelines ◽  
Evidence Based Guidelines

Background: Many organisations in Australia undertake systematic reviews to inform development of evidence-based guidelines or would like to do so. However, the substantial resources required to produce systematic reviews limit the feasibility of evidence-based approaches to guideline development. We are working with Australian guideline developers to design, build and test systems that make creating evidence-based guidelines easier and more efficient. Methods: To understand the evidence needs of guideline developers and to inform the development of potential tools and services, we conducted 16 semi-structured interviews with Australian guideline developers. Developers were involved in different types of guidelines, represented both new and established guideline groups, and had access to widely different levels of resources. Results: All guideline developers recognised the importance of having access to timely evidence to support their processes, but were frequently overwhelmed by the scale of this task. Groups developing new guidelines often underestimated the time, expertise and work involved in completing searching and screening. Many were grappling with the challenge of updating and were keen to explore alternatives to the blanket updating of the full guideline. Horizon-scanning and evidence signalling were seen as providing more pragmatic approaches to updating, although some were wary of challenges posed by receiving evidence on a too-frequent basis. Respondents were aware that new technologies, such as machine learning, offered potentially large time and resource savings. Conclusions: As well as the constant challenge of managing financial constraints, Australian guideline developers seeking to develop clinical guidelines face several critical challenges. These include acquiring appropriate methodological expertise, investing in information technology, coping with the proliferation of research output, feasible publication and dissemination options, and keeping guidance up to date.

scholarly journals Wiki-Based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma: A New Paradigm in Sarcoma Evidence

Sarcoma ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
S. J. Neuhaus ◽  
D. Thomas ◽  
J. Desai ◽  
C. Vuletich ◽  
J. von Dincklage ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Lessons Learned ◽  
Evidence Based ◽  
Adult Onset ◽  
New Paradigm ◽  
Software Application ◽  
Evidence Based Guidelines

In 2013 Australia introduced Wiki-based Clinical Practice Guidelines for the Management of Adult Onset Sarcoma. These guidelines utilized a customized MediaWiki software application for guideline development and are the first evidence-based guidelines for clinical management of sarcoma. This paper presents our experience with developing and implementing web-based interactive guidelines and reviews some of the challenges and lessons from adopting an evidence-based (rather than consensus-based) approach to clinical sarcoma guidelines. Digital guidelines can be easily updated with new evidence, continuously reviewed and widely disseminated. They provide an accessible method of enabling clinicians and consumers to access evidence-based clinical practice recommendations and, as evidenced by over 2000 views in the first four months after release, with 49% of those visits being from countries outside of Australia. The lessons learned have relevance to other rare cancers in addition to the international sarcoma community.

Developing the evidence base for the new guidelines for reduction of cardiovascular risk for children by the National Heart, Lung, and Blood Institute

2011 ◽  
Vol 21 (S2) ◽  
pp. 165-168
Author(s):  
Samuel S. Gidding
Keyword(s):  
Cardiovascular Risk ◽  
Evidence Base ◽  
Evidence Based ◽  
Blood Institute ◽  
National Heart ◽  
Congenital Cardiac Disease ◽  
National Heart Lung ◽  
New Guidelines ◽  
Evidenced Based ◽  
Evidence Based Guidelines

AbstractIn 2006, a process was initiated to develop evidence-based paediatric guidelines directed towards physicians for reduction of cardiovascular risk. In contrast to prior consensus-based guidelines from the National Heart, Lung, and Blood Institute, this process was to be evidenced based. This manuscript describes the process undertaken to write the evidence-based guidelines from the National Heart, Lung, and Blood Institute, beginning with the search for evidence, then the process of review of the evidence, and finally the writing of the final document. This manuscript also provides some thoughts on how this process might be adapted in developing guidelines for caring for patients with congenital cardiac disease.

scholarly journals Navigating complexity of child abuse through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

2020 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Care Practice ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines

Abstract Background: Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-practitioners use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are necessary in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-practitioners when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines.Methods: A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-physicians focused on perceptions on intuition, which were followed by a survey amongst CYHC-practitioners on the recognition and use of the concept.Results: The majority of CYHC-practitioners recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition to 1) sense that something is ‘off’, 2) differentiate between ‘normal’ and ‘abnormal’, 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn of its dangers, as it may lead to ‘tunnel vision’ and false accusations. Conclusion: Intuition is experienced as an integral part of the work of CYHC-practitioners. It is understood as particularly useful in cases of child abuse, which are inherently complex, as signs and evidence of abuse are often hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a ‘good care’ practice.

scholarly journals The views of health guideline developers on the use of automation in health evidence synthesis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Anneliese Arno ◽  
Julian Elliott ◽  
Byron Wallace ◽  
Tari Turner ◽  
James Thomas
Keyword(s):  
Diffusion Of Innovation ◽  
Systematic Reviews ◽  
Diffusion Of Innovations ◽  
New Technologies ◽  
Guideline Development ◽  
Evidence Synthesis ◽  
Analytical Framework ◽  
Relative Advantage ◽  
Full Potential ◽  
Novel Technologies

Abstract Background The increasingly rapid rate of evidence publication has made it difficult for evidence synthesis—systematic reviews and health guidelines—to be continually kept up to date. One proposed solution for this is the use of automation in health evidence synthesis. Guideline developers are key gatekeepers in the acceptance and use of evidence, and therefore, their opinions on the potential use of automation are crucial. Methods The objective of this study was to analyze the attitudes of guideline developers towards the use of automation in health evidence synthesis. The Diffusion of Innovations framework was chosen as an initial analytical framework because it encapsulates some of the core issues which are thought to affect the adoption of new innovations in practice. This well-established theory posits five dimensions which affect the adoption of novel technologies: Relative Advantage, Compatibility, Complexity, Trialability, and Observability. Eighteen interviews were conducted with individuals who were currently working, or had previously worked, in guideline development. After transcription, a multiphase mixed deductive and grounded approach was used to analyze the data. First, transcripts were coded with a deductive approach using Rogers’ Diffusion of Innovation as the top-level themes. Second, sub-themes within the framework were identified using a grounded approach. Results Participants were consistently most concerned with the extent to which an innovation is in line with current values and practices (i.e., Compatibility in the Diffusion of Innovations framework). Participants were also concerned with Relative Advantage and Observability, which were discussed in approximately equal amounts. For the latter, participants expressed a desire for transparency in the methodology of automation software. Participants were noticeably less interested in Complexity and Trialability, which were discussed infrequently. These results were reasonably consistent across all participants. Conclusions If machine learning and other automation technologies are to be used more widely and to their full potential in systematic reviews and guideline development, it is crucial to ensure new technologies are in line with current values and practice. It will also be important to maximize the transparency of the methods of these technologies to address the concerns of guideline developers.

scholarly journals Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

2019 ◽  
Author(s):  
Jetske Charlotte Erisman ◽  
Kevin de Sabbata ◽  
Teun Zuiderent-Jerak ◽  
Elena V Syurina
Keyword(s):  
Child Abuse ◽  
Well Being ◽  
Evidence Based ◽  
Structured Interviews ◽  
Daily Work ◽  
Tunnel Vision ◽  
Dutch Child ◽  
Secondary Information ◽  
Evidence Based Guidelines ◽  
Based Medicine

Abstract Background Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of all children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. They use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to understand how Dutch CYHC-practitioners perceive the role of intuition in their work and in relation to evidence-based medicine, in the case of child abuse.Methods A sequential exploratory mixed-methods design. In-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which was followed by a survey amongst CYHC-professionals on the recognition and use of the concept.Results The majority of CYHC-practitioners and professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition: 1) to sense that something is off, 2) to differentiate between ‘normal’ and ‘abnormal’, 3) to assess risks, 4) to weigh secondary information and 5) to communicate with parents. At the same time, they warn for its dangers as it may lead to tunnel vision and false accusations. Their ways of working with intuition show parallels to the practices that evidence-based guidelines try to support.Conclusion Intuition is experienced as an integral part of the work of CYHC-practitioners. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. As there is a lack of guidance on how to practice intuition, there is a need for support through guidelines.

scholarly journals Uncertainty and the Development of Evidence-Based Guidelines

2014 ◽  
Vol 2 (1) ◽  
pp. 43-64 ◽  
Author(s):  
Esther Van Loon ◽  
Roland Bal
Keyword(s):  
Clinical Practice ◽  
Guideline Development ◽  
Evidence Based ◽  
The Core ◽  
Types Of Knowledge ◽  
The Creation ◽  
Knowledge Form ◽  
Evidence Based Guideline ◽  
Evidence Based Guidelines

This article explores how developers address uncertainty in the creation of an evidence-based guideline (EBG). As the aim of an EBG is to assist healthcare practitioners in situations of doubt, it is easy to assume that uncertainty has no place in guidelines. However, as we discovered, guideline development does not ignore uncertainty but seeks to accept it while establishing credible recommendations for healthcare. Dealing with omissions in knowledge, ignorance, or challenges in valuating different sorts of knowledge form the core of the work of guideline developers. Interviewing guideline developers, we found three types of valuation work: classifying studies, grading types of knowledge, and involving expertise and clinical practice. These methods have consequences for the credibility, and amount and kind of uncertainty EBGs can include.

scholarly journals The views of health guideline developers on the use of automation in health evidence synthesis

2020 ◽  
Author(s):  
Anneliese Downey Arno ◽  
Julian Elliott ◽  
Byron Wallace ◽  
Tari Turner ◽  
James Thomas
Keyword(s):  
Diffusion Of Innovation ◽  
Systematic Reviews ◽  
Diffusion Of Innovations ◽  
New Technologies ◽  
Guideline Development ◽  
Evidence Synthesis ◽  
Analytical Framework ◽  
Relative Advantage ◽  
Full Potential ◽  
Novel Technologies

Abstract Background: The increasingly rapid rate of evidence publication has made it difficult for evidence synthesis – systematic reviews and health guidelines -- to be continually kept up to date. One proposed solution for this is the use of automation in health evidence synthesis. Guideline developers are key gatekeepers in the acceptance and use of evidence, and therefore their opinions on the potential use of automation are crucial. Methods: The objective of this study was to analyze the attitudes of guideline developers towards the use of automation in health evidence synthesis. The Diffusion of Innovations framework was chosen as an initial analytical framework because it encapsulates some of the core issues which are thought to affect the adoption of new innovations in practice. This well-established theory posits five dimensions which affect the adoption of novel technologies: Relative Advantage, Compatibility, Complexity, Trialability, and Observability.Eighteen interviews were conducted with individuals who were currently working, or had previously worked, in guideline development. After transcription, a multiphase mixed deductive and grounded approach was used to analyze the data. First, transcripts were coded with a deductive approach using Rogers’ Diffusion of Innovation as the top-level themes. Second, sub-themes within the framework were identified using a grounded approach.Results: Participants were consistently most concerned with the extent to which an innovation is in line with current values and practices (i.e. Compatibility in the Diffusion of Innovations framework). Participants were also concerned with Relative Advantage and Observability, which were discussed in approximately equal amounts. For the latter, participants expressed a desire for transparency in methodology of automation software. Participants were noticeably less interested in Complexity and Trialability, which were discussed infrequently. These results were reasonably consistent across all participants. Conclusions: If machine learning and other automation technologies are to be used more widely and to their full potential in systematic reviews and guideline development, it is crucial to ensure new technologies are in line with current values and practice. It will also be important to maximize the transparency of the methods of these technologies to address the concerns of guideline developers.

scholarly journals The views of health guideline developers on the use of automation in health evidence synthesis

2020 ◽  
Author(s):  
Anneliese Downey Arno ◽  
Julian Elliott ◽  
Byron Wallace ◽  
Tari Turner ◽  
James Thomas
Keyword(s):  
Machine Learning ◽  
Systematic Reviews ◽  
Diffusion Of Innovations ◽  
New Technologies ◽  
Guideline Development ◽  
Evidence Synthesis ◽  
Relative Advantage ◽  
Full Potential ◽  
Crowd Sourcing ◽  
Novel Technologies

Abstract Background The increasingly rapid rate of evidence publication has made it difficult for evidence synthesis – systematic reviews and health guidelines -- to be continually kept up-to-date maintain the most up-to-date data. One proposed solution for this is the use of automation in health evidence synthesis. Guideline developers are key gatekeepers in the acceptance and use of evidence, and therefore their opinions on the potential use of automation are crucial. Methods The objective of this study was to analyse the attitudes of guideline developers towards the use of machine learning and crowd-sourcing in evidence. The Diffusion of Innovations framework was chosen as an initial analytical framework because it encapsulates some of the core issues which are thought to affect the adoption of new innovations in practice. This well-established theory posits five dimensions which affect the adoption of novel technologies: Relative Advantage , Compatibility , Complexity , Trialability , and Observability . Eighteen interviews were conducted with individuals who were currently working, or had previously worked, in guideline development. After transcription, a multiphase mixed deductive and grounded approach was used to analyse the data. First, transcripts were coded with a deductive approach using Rogers’ Diffusion of Innovation as the top-level themes. Second, sub-themes within the framework were identified using a grounded approach. Results Participants were consistently most concerned with the extent to which an innovation is in line with current values and practices (ie. Compatibility in the Diffusion of Innovations framework. Participants were also concerned with Relative Advantage and Observability , which were discussed in approximately equal amounts. For the latter, participants expressed a desire for transparency in methodology of automation software. Participants were noticeably less interested in Complexity and Trialability , which were discussed infrequently. These results were reasonably consistent across all participants. Conclusions If machine learning and other automation technologies are to be used more widely and to their full potential in systematic reviews and guideline development, it is crucial to ensure new technologies are in line with current values and practice. It will also be important to maximize the transparency of the methods of these technologies to address the concerns of guideline developers.

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