Data from: Multilayered and digitally structured presentation formats of trustworthy recommendations: a combined survey and randomised trial

Objectives: To investigate practicing physicians preferences, perceived usefulness and understanding of a new multilayered guideline presentation format - compared to a standard format - as well as conceptual understanding of trustworthy guideline concepts. Design: Mixed survey and randomized controlled trial through a standardised lecture for physicians. We presented participants with a clinical scenario and randomised them to view a guideline recommendation in multilayered or standard format. Both groups were presented and asked about guideline concepts. Participants answered multiple-choice questions by use of clickers. Setting: Mandatory educational lectures in six non-academic and academic hospitals and three primary care centres in Lebanon, Norway, Spain and United Kingdom. Participants: 181 practicing physicians in internal medicine (156) and general practice (25) attending the lectures. Interventions: A new digitally structured, multilayered guideline presentation format and a standard narrative presentation format currently in widespread use. Primary and secondary outcome measures: Our primary outcome was preference for presentation format. Understanding, perceived usefulness and perception of absolute effects were secondary outcomes. Results: 72% (95% CI 65-79) of participants preferred the multilayered format and 16% (95% CI 10-22) preferred the standard format. A majority agreed that recommendations (multilayered 86% vs. standard 91%, p-value = 0.31) and evidence summaries (79% vs. 77%, p-value = 0.76) were useful in the context of the clinical scenario. 72% of participants randomised to the multilayered format vs. 58% for standard formats reported correct understanding of the recommendations (p-value = 0.06). Most participants elected an appropriate clinical action after viewing the recommendations (98% vs. 92%, p-value = 0.10). 82% of the participants considered absolute effect estimates in evidence summaries helpful or crucial. Conclusions: Clinicians clearly preferred a novel multilayered presentation format to the standard format. Whether the preferred format improves decision-making and has an impact on patient important outcomes merits further investigation. Trial registration: None.

研究目的：旨在探究执业医师对新型多层级指南呈现格式相较于标准格式的偏好、感知有用性与理解程度，以及对可信指南相关概念的概念性理解。
研究设计：采用混合调查与随机对照试验（Randomized Controlled Trial）设计，通过面向医师的标准化授课开展研究。向受试者呈现临床场景，并将其随机分配至多层级格式组或标准格式组以查看指南推荐意见。两组受试者均需完成与指南概念相关的问答环节，并通过答题器完成多项选择题作答。
研究场景：于黎巴嫩、挪威、西班牙及英国的6家非学术型与学术型医院，以及3家基层医疗中心开展的强制性教育授课。
研究对象：181名执业医师，其中内科医师156名、全科医师25名，均参与了本次授课。
干预措施：新型数字化结构化多层级指南呈现格式，以及目前临床广泛使用的标准叙事式呈现格式。
主要与次要结局指标：本研究的主要结局为受试者对指南呈现格式的偏好。次要结局包括对指南概念的理解程度、感知有用性，以及对绝对效应的认知情况。
研究结果：72%（95%置信区间CI 65~79）的受试者偏好多层级格式，16%（95% CI 10~22）偏好标准格式。多数受试者认为指南推荐意见（多层级组86% vs 标准组91%，P=0.31）与证据总结（79% vs 77%，P=0.76）在本次临床场景中具有实用价值。被分配至多层级格式组的受试者中，72%正确理解了指南推荐意见，标准格式组则为58%（P=0.06）。多数受试者在查看推荐意见后选择了恰当的临床处置方案（98% vs 92%，P=0.10）。82%的受试者认为证据总结中的绝对效应值估计具有帮助性或至关重要性。
研究结论：临床医师明显更偏好新型多层级指南呈现格式。但该优选格式是否可改善临床决策，并对患者重要结局产生影响，仍有待进一步研究验证。
试验注册：无。