title: Multilayered and digitally structured presentation formats of trustworthy recommendations: a combined survey and randomised trial.
abstract: To investigate practicing physicians' preferences, perceived usefulness and understanding of a new multilayered guideline presentation format-compared to a standard format-as well as conceptual understanding of trustworthy guideline concepts.
  
  
  
  Participants attended a standardised lecture in which they were presented with a clinical scenario and randomised to view a guideline recommendation in a multilayered format or standard format after which they answered multiple-choice questions using clickers. Both groups were also presented and asked about guideline concepts.
  
  
  
  Mandatory educational lectures in 7 non-academic and academic hospitals, and 2 settings involving primary care in Lebanon, Norway, Spain and the UK.
  
  
  
  181 practicing physicians in internal medicine (156) and general practice (25).
  
  
  
  A new digitally structured, multilayered guideline presentation format and a standard narrative presentation format currently in widespread use.
  
  
  
  Our primary outcome was preference for presentation format. Understanding, perceived usefulness and perception of absolute effects were secondary outcomes.
  
  
  
  72% (95% CI 65 to 79) of participants preferred the multilayered format and 16% (95% CI 10 to 22) preferred the standard format. A majority agreed that recommendations (multilayered 86% vs standard 91%, p value=0.31) and evidence summaries (79% vs 77%, p value=0.76) were useful in the context of the clinical scenario. 72% of participants randomised to the multilayered format vs 58% for standard formats reported correct understanding of the recommendations (p value=0.06). Most participants elected an appropriate clinical action after viewing the recommendations (98% vs 92%, p value=0.10). 82% of the participants considered absolute effect estimates in evidence summaries helpful or crucial.
  
  
  
  Clinicians clearly preferred a novel multilayered presentation format to the standard format. Whether the preferred format improves decision-making and has an impact on patient important outcomes merits further investigation.
authors.affiliation: Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway.|Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Linn
authors.identifier: 0000-0002-3802-6543
authors.initials: L
authors.lastname: Brandt
authors.affiliation: Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway.|Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Per Olav
authors.initials: PO
authors.lastname: Vandvik
authors.affiliation: Iberoamerican Cochrane Centre, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.affiliation: National Institute for Health and Care Excellence, Manchester, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Thornton
authors.affiliation: Iberoamerican Cochrane Centre, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Rigau
authors.affiliation: National Institute for Health and Care Excellence, Manchester, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Adams
authors.affiliation: National Institute for Health and Care Excellence, Manchester, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Connor
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway.|Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Annette
authors.initials: A
authors.lastname: Kristiansen
mesh_terms: D003258:Consumer Behavior; D003626:Data Display; D058005:General Practitioners; D006801:Humans; D007388:Internal Medicine; D007861:Lebanon; D009664:Norway; D058007:Physicians, Primary Care; D017410:Practice Guidelines as Topic; D013030:Spain; D006113:United Kingdom
keywords: EPIDEMIOLOGY