Decision Making
Conditions
Keywords
practice guideline as topic, decision making, evidence based medicine
Brief summary
Clinical practice guidelines (CPG) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. They are developed to give a recommendation based on the best evidence available. Through a randomized trial, the investigators intend to provide information about which of the four grading systems most used today to grade evidence and recommendations in CPGs, could change physician´s behavior towards a common clinical situation in daily practice.
Detailed description
Clinical practice guidelines (CPG) are used by professional and consumer organizations who are demanding more rigorous processes to ensure that health decisions are well informed by the best available research evidence. More than 60 different grading systems are used today to grade evidence and recommendations in CPGs. The investigators aimed to provide information about which of the four most common grading systems used today (GRADE, SIGN, NICE and CEBM-Oxford) could change physician´s behavior when reading a clinical recommendation in a CPG. The investigators will randomize 216 pediatricians and pediatricians in training into four groups (one for each grading system) to read a clinical case and to make a decision before reading the CPG statement graded with any of the four grading systems. After that they will re-consider their answer and post a new one based on the graded recommendation. The investigators will measure change in their decision and among groups.
Interventions
OTHERGraded Clinical Recommendation
Graded recommendation in reference to a clinical condition written as it would be in a clinical practice guideline
Sponsors
Instituto Tecnologico y de Estudios Superiores de Monterey
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* Pediatricians and residents in pediatrics
Exclusion criteria
* Less than six months in clinical practice
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Behavior in Physicians Attitude Towards a Decision to Give a Medication | One day | A fictitious clinical case of a child with acute diarrhea was presented. The physician read the case and then answered the question would you recommend racecadotril to this patient? A zero to 10 visual-analog scale and a Likert scale were used to measure the decision of the physician related to the clinical case presented (from zero=definitely no to 10=definitely yes). Mean differences before-after and among groups were measured on the 10 centimeters scale. |
Countries
Mexico
Participant flow
Recruitment details
Pediatric residents, pediatricians and sub-specialists were recruited from their clinical practices to participate in the study. All in known teaching hospitals in Monterrey and Mexico city. Recruitment from September 1st to October 21st.
Pre-assignment details
Participants were not eligible for randomization if they refuse to participate in the trial or if they reported less than six months of clinical practice (residents). After randomization they were allocated to one of the four study groups. A survey was applied and no wash out was observed or desertions.
Participants by arm
| Arm | Count |
|---|---|
| GRADE System A clinical recommendation built and graded with the GRADE working group system | 54 |
| SIGN Grading System A clinical recommendation built and graded with the Scottish Intercollegiate Guidelines Network system | 53 |
| NICE Grading System A clinical recommendation built and graded with National Institute of Clinical Excellence grading system | 55 |
| CEBM-Oxford A clinical recommendation built and graded with the Centre for Evidence-Based Medicine grading system | 54 |
| Total | 216 |
Baseline characteristics
| Characteristic | GRADE System | SIGN Grading System | NICE Grading System | CEBM-Oxford | Total |
|---|---|---|---|---|---|
| Age Continuous | 30 years | 34 years | 31 years | 38 years | 32 years |
| Sex: Female, Male Female | 25 Participants | 27 Participants | 25 Participants | 25 Participants | 102 Participants |
| Sex: Female, Male Male | 29 Participants | 26 Participants | 30 Participants | 29 Participants | 114 Participants |
| Years of practice Years of practice | 4 Years | 5 Years | 4 Years | 9 Years | 5 Years |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Change in Behavior in Physicians Attitude Towards a Decision to Give a Medication
A fictitious clinical case of a child with acute diarrhea was presented. The physician read the case and then answered the question would you recommend racecadotril to this patient? A zero to 10 visual-analog scale and a Likert scale were used to measure the decision of the physician related to the clinical case presented (from zero=definitely no to 10=definitely yes). Mean differences before-after and among groups were measured on the 10 centimeters scale.
Time frame: One day
| Arm | Measure | Value (MEAN) |
|---|---|---|
| GRADE System | Change in Behavior in Physicians Attitude Towards a Decision to Give a Medication | 2.18 Mean change in centimeters |
| SIGN Grading System | Change in Behavior in Physicians Attitude Towards a Decision to Give a Medication | 0.31 Mean change in centimeters |
| NICE Grading System | Change in Behavior in Physicians Attitude Towards a Decision to Give a Medication | 0.04 Mean change in centimeters |
| CEBM-Oxford | Change in Behavior in Physicians Attitude Towards a Decision to Give a Medication | 0.08 Mean change in centimeters |
Comparison: After reading the clinical practice guideline, the median response from the four groups were compared using the Kruskal-Wallis statisticp-value: 0.007Kruskal-Wallis