Development of a novel multilayered presentation format for clinical practice guidelines

Annette Kristiansen, Linn Brandt, Pablo Alonso-Coello, Thomas Agoritsas, Elie A Akl, Tara Conboy, Mahmoud Elbarbary, Mazen Ferwana, Wedad Medani, Mohammad Hassan Murad, David Rigau, Sarah Rosenbaum, Frederick A Spencer, Shaun Treweek, Gordon Guyatt, Per Olav Vandvik

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)


Background: Bridging the gap between clinical research and everyday healthcare 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 semi-structured 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.

Conclusion: We have developed an electronic multilayered CPG format that enhances the usability of CPGs for front-line clinicians. We have implemented the format in electronic guideline tools which guideline organizations can now use when authoring and publishing their guidelines.

Original languageEnglish
Pages (from-to)754-763
Number of pages20
Issue number3
Early online date21 Dec 2014
Publication statusPublished - Mar 2015


  • Clinical Practice Guidelines
  • Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence
  • Grading of Recommendations Assessment, Development, and Evaluation
  • Making Grade the Irresistible Choice


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