Practice Guidelines Grading Systems

Study Overview
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Brief Summary
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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
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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.

Official Title
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Different Grading Systems to Grade Evidence and Recommendations in Clinical Practice Guidelines: Does it Influence the Clinicians´ Behavior?

Conditions
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Decision Making

Intervention / Treatment
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* Other: Graded Clinical Recommendation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pediatricians and residents in pediatrics Exclusion Criteria: Less than six months in clinical practice
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: GRADE system<br>A clinical recommendation built and graded with the GRADE working group system | Other: Graded Clinical Recommendation<br>* Graded recommendation in reference to a clinical condition written as it would be in a clinical practice guideline<br>|
| Other: SIGN grading system<br>A clinical recommendation built and graded with the Scottish Intercollegiate Guidelines Network system | Other: Graded Clinical Recommendation<br>* Graded recommendation in reference to a clinical condition written as it would be in a clinical practice guideline<br>|
| Other: NICE grading system<br>A clinical recommendation built and graded with National Institute of Clinical Excellence grading system | Other: Graded Clinical Recommendation<br>* Graded recommendation in reference to a clinical condition written as it would be in a clinical practice guideline<br>|
| Other: CEBM-Oxford<br>A clinical recommendation built and graded with the Centre for Evidence-Based Medicine grading system | Other: Graded Clinical Recommendation<br>* Graded recommendation in reference to a clinical condition written as it would be in a clinical practice guideline<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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. | One day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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practice guideline as topic, decision making, evidence based medicine