title: Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review.
abstract: OBJECTIVE
  To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake.
  
  
  METHODS
  We conducted a realist review, which involved searching multiple sources (eg, databases, experts) to determine what about guideline implementability works, for whom, and under what circumstances. Two sets of reviewers independently screened abstracts and extracted data from 278 included studies. Analysis involved the development of a codebook of definitions, validation of data, and development of hierarchical narratives to explain guideline implementability.
  
  
  RESULTS
  We found that guideline implementability is associated with two broad goals in guideline development: (1) creation of guideline content, which involves addressing the domains of stakeholder involvement in CPGs, evidence synthesis, considered judgment (eg, clinical applicability), and implementation feasibility and (2) the effective communication of this content, which involves domains related to fine-tuning the CPG's message (using simple, clear, and persuasive language) and format.
  
  
  CONCLUSIONS
  Our work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care.
authors: Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8. Electronic address: monika.kastner@utoronto.ca.
authors: Monika
authors: M
authors: Kastner
authors: Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8; Keenan Research Centre of LKSKI of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8.
authors: Onil
authors: O
authors: Bhattacharyya
authors: Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8.
authors: Leigh
authors: L
authors: Hayden
authors: Department of Oncology, Escarpment Cancer Research Institute, McMaster University, 699 Concession Street, Hamilton, Ontario, L8V 5C2.
authors: Julie
authors: J
authors: Makarski
authors: Strategic Policy, Planning & Initiatives, Health Services, Region of Peel, 10 Peel Centre Drive, 2nd Floor, Brampton, Ontario, Canada, L6T 4B9.
authors: Elizabeth
authors: E
authors: Estey
authors: Department of Oncology, Escarpment Cancer Research Institute, McMaster University, 699 Concession Street, Hamilton, Ontario, L8V 5C2.
authors: Lisa
authors: L
authors: Durocher
authors: Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8.
authors: Ananda
authors: A
authors: Chatterjee
authors: Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8; Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 650, Toronto, Ontario, Canada, M5G 1V7.
authors: Laure
authors: L
authors: Perrier
authors: Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, University of Ottawa, 725 Parkdale Avenue, Ottawa, Ontario, Canada K1Y 4E9.
authors: Ian D
authors: ID
authors: Graham
authors: Li Ka Shing Knowledge Institute (LKSKI) of St. Michael's Hospital, Knowledge Translation Program. 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8; Keenan Research Centre of LKSKI of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, Canada, M5B 1W8; Faculty of Medicine, University of Toronto, 563 Spadina Crescent, Toronto, Ontario, Canada, M5S 2J7.
authors: Sharon E
authors: SE
authors: Straus
authors: Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, Clinical Skills Building, London, Ontario, Canada, N6A 5C1.
authors: Merrick
authors: M
authors: Zwarenstein
authors: Department of Oncology, Escarpment Cancer Research Institute, McMaster University, 699 Concession Street, Hamilton, Ontario, L8V 5C2.
authors: Melissa
authors: M
authors: Brouwers
mesh_terms: D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D057170:Translational Research, Biomedical
keywords: Clinical practice guideline; Guideline adherence; Guideline implementability; Realist review; Systematic review