title: Development of a novel, multilayered presentation format for clinical practice guidelines.
abstract: BACKGROUND
  Bridging the gap between clinical research and everyday health-care practice requires effective communication strategies. To address current shortcomings in conveying practice recommendations and supporting evidence, we are creating and testing presentation formats for clinical practice guidelines (CPGs).
  
  
  METHODS
  We carried out multiple cycles of brainstorming and sketching, developing a prototype. Physicians participating in the user testing viewed CPG formats linked to clinical scenarios and engaged in semistructured interviews applying a think-aloud method for exploring important aspects of user experience.
  
  
  RESULTS
  We developed a multilayered presentation format that allows clinicians to successively view more in-depth information. Starting with the recommendations, clinicians can, on demand, access a rationale and a key information section containing statements on quality of the evidence, balance between desirable and undesirable consequences, values and preferences, and resource considerations. We collected feedback from 27 stakeholders and performed user testing with 47 practicing physicians from six countries. Advisory group feedback and user testing of the first version revealed problems with conceptual understanding of underlying CPG methodology, as well as difficulties with the complexity of the layout and content. Extensive revisions made before the second round of user testing resulted in most participants expressing overall satisfaction with the final presentation format.
  
  
  CONCLUSIONS
  We have developed an electronic, multilayered, CPG format that enhances the usability of CPGs for frontline clinicians. We have implemented the format in electronic guideline tools that guideline organizations can now use when authoring and publishing their guidelines.
authors.affiliation: Department of Internal Medicine, Institute for Health and Society, Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Annette
authors.initials: A
authors.lastname: Kristiansen
authors.affiliation: Department of Internal Medicine, Institute for Health and Society, Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Linn
authors.initials: L
authors.lastname: Brandt
authors.affiliation: Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Institute of Biomedical Research, Sant Pau, Spain. Electronic address: rachael.evans@uhl-tr.nhs.uk.
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Agoritsas
authors.affiliation: Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: National & Gulf Center for Evidence Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Tara
authors.initials: T
authors.lastname: Conboy
authors.affiliation: National & Gulf Center for Evidence Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Elbarbary
authors.affiliation: National & Gulf Center for Evidence Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Mazen
authors.initials: M
authors.lastname: Ferwana
authors.affiliation: National & Gulf Center for Evidence Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Wedad
authors.initials: W
authors.lastname: Medani
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Institute of Biomedical Research, Sant Pau, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Rigau
authors.affiliation: The Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rosenbaum
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland.
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Department of Internal Medicine, Institute for Health and Society, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Per Olav
authors.initials: PO
authors.lastname: Vandvik
mesh_terms: D035843:Biomedical Research; D004581:Electronics; D006801:Humans; D033183:Interdisciplinary Communication; D007391:International Cooperation; D007407:Interviews as Topic; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011643:Publishing