7 March 2011

Dundee leading the way in 'DECIDE-ing' healthcare guidelines

The University of Dundee and the Norwegian Knowledge Centre for the Health Services are leading a 3 million euros, Europe-wide project aimed at developing better systems of communicating healthcare guidelines.

The five-year DECIDE project is funded by the European Commission’s 7th Framework Programme and is designed to research and improve the way healthcare evidence and recommendations are presented in guidelines.

It is widely recognised that healthcare decision makers can face challenges in understanding both new and existing guidelines, including the quality of the evidence upon which recommendations are made, which often is not clear.

Guidelines are also typically developed as a one-size-fits-all package, despite having to address considerably different audiences.

'We see new health guidelines being issued on a regular basis and they have to reach very different audiences, from policy makers in Government and healthcare authorities to the general public,' said Dr Shaun Treweek, lead researcher on the project based within the School of Medicine at the University of Dundee.

'There has already been a great deal of work done over the past ten years towards developing a systematic approach of assessing and communicating the quality of evidence and the strength of recommendations. This is the GRADE system which is now widely used internationally.

'This new project involves members of the GRADE Working Group and will further refine the system to ensure effective dissemination of evidence-based recommendations targeted at the key people - healthcare professionals; policymakers and managers; patients and the general public - who determine what happens in clinical practice.

'This is a key area because it is vital we effectively communicate the results of new research to health professionals, patients and others so as to transfer the results of that research into practice.'

The project includes a number of international partners including the UK’s National Institute for Health and Clinical Excellence (NICE), the World Health Organisation (WHO), the Scottish Intercollegiate Guidelines Network (SIGN), the Italian Cochrane Centre and several other European national guidelines developers.

'The whole point is to develop dissemination strategies that can be applied to different audiences in different healthcare systems, so we have included partners from around Europe to best meet that need,' said Dr Treweek.

'Previously people have tried to get this information out using a `one size fits all’ approach. A lot of times research results and the guidelines arising around them can be quite confusing, or fail to present information about the quality of evidence behind recommendations.

'This project will look at ways of developing more flexible systems that can be applied in different ways depending on the audience we are trying to reach.'

DECIDE will work with healthcare professionals, policymakers, managers, patients and the general public to develop and evaluate dissemination strategies that are tailored to their needs. For example, earlier work with policymakers done by DECIDE partners found that while policymakers were interested in precision, there was confusion around what the different numbers referred to. Work with health professionals revealed difficulties with how to present continuous outcomes.

Key elements of the project are user-testing (what do guideline users think of the ideas coming from the brainstorming and stakeholder work) and evaluating potential strategies in trials. The latter will involve randomising users (e.g. family doctors) to receive research evidence and recommendations presented in different ways and then measuring attitudes and understanding, among others. This will be done in at least seven European countries. At the end of this process, promising strategies will be tested in real guidelines.

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