Protocol Development and Quality Improvement
| (d) | Makes the decision-making process transparent to colleagues and patients |
|---|---|
| (e) | Leads to greater appreciation of the evidence for our practice as well as the inherent |
uncertainties
ii.
Disadvantages
| (a) | Time-consuming |
|---|---|
| (b) | Sometimes impossible (when there is no published literature on a question) |
| (c) | Useful papers may be disregarded because of minor blemishes (rescue bias). |
| (d) | Contradictory study findings leading to differences in interpretation of benefit |
| (e) | No science to tell us how robust the evidence must be for it to be incorporated into clinical |
practice
| (f) | External validity is subjective, and evidence can be misapplied. |
|---|---|
| (g) | Easy-to-prove techniques more favored in literature |
| (h) | It is never “up-to-date.” |
| (i) | Tends to emphasize the priority of randomized controlled trials (which have inherent flaws) |
to the exclusion of other study designs (which may be appropriate in certain settings)
| (j) | May underemphasize patient values and interests |
|---|---|
| (k) | Publications with favorable results are more likely to be published than are those without |
favorable results (publication bias).
Barriers to implementing evidence
Practice environment (organizational context)
Financial disincentives – Lack of reimbursement
ii.
Organizational constraints – Lack of time; insufficient leadership or administrative support;
staffing, equipment, or resource constraints
iii.
Perception of liability – Risk of formal complaint
iv.
The patient’s expectations – Expressed wishes related to care
Prevailing opinion (social context)
Standard work – Usual routine
ii.
Opinion leaders – Key individuals not in agreement with evidence
iii.
Medical training – Obsolete knowledge
iv.
Advocacy – By pharmaceutical companies
Knowledge, skills, and attitudes (professional context)
Clinical uncertainty – Necessary test for vague symptoms
ii.
Sense of competence – Self-confidence in skills
iii.
Compulsion to act – Need to do something
iv.
Information overload – Inability to appraise evidence
Scope and purpose
Objectives are specifically described.
Health questions covered by the guideline are specifically described.
The patient population to which the guideline applies is specifically described.
Guideline development group includes individuals relevant to the guideline.
Target population’s views and preferences have been identified.
Target users of the guideline are defined.
Development of guideline
Literature search is systematic.
Criteria for selecting evidence are clearly defined.