umu.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
Department of Business Administration, Technology and Social Sciences, Luleå University of Technology.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet.ORCID-id: 0000-0003-2281-4622
2017 (Engelska)Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, nr 1, artikel-id 344Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease.

METHODS: A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data.

RESULTS: The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals' relative influence on group discussions.

CONCLUSIONS: The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2017. Vol. 17, nr 1, artikel-id 344
Nyckelord [en]
Clinical practice guidelines, Evidence-based policy-making, Group decision making, Guideline development, Prevention
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
URN: urn:nbn:se:umu:diva-134803DOI: 10.1186/s12913-017-2277-1ISI: 000403096400001PubMedID: 28490325OAI: oai:DiVA.org:umu-134803DiVA, id: diva2:1095203
Tillgänglig från: 2017-05-12 Skapad: 2017-05-12 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

Open Access i DiVA

fulltext(1375 kB)109 nedladdningar
Filinformation
Filnamn FULLTEXT01.pdfFilstorlek 1375 kBChecksumma SHA-512
df93b36b7ea3ccabc3a4d1a9d09d08db7d03b80555ae3f32e1dd445cbf0009a1d2ea5909c56ba65b062817bfb37b95135bf6a22b8447f45111634a1f2b35422f
Typ fulltextMimetyp application/pdf

Övriga länkar

Förlagets fulltextPubMed

Personposter BETA

Richter Sundberg, LindaNyström, Monica Elisabeth

Sök vidare i DiVA

Av författaren/redaktören
Richter Sundberg, LindaNyström, Monica Elisabeth
Av organisationen
Epidemiologi och global hälsaBarn- och ungdomspsykiatri
I samma tidskrift
BMC Health Services Research
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologiHälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 109 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

doi
pubmed
urn-nbn

Altmetricpoäng

doi
pubmed
urn-nbn
Totalt: 606 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf