Friday, September 24, 2021

6 Simple Rules for Creating a Plain Language Summary of a GRADE Guideline Recommendation

While seasoned clinicians and methodheads may consider the nuances of clinical guideline development everyday fare, there is generally a lack of awareness among the public about the implications and use of guidelines. In addition, there is some evidence of public concern that guidelines may be used to ration care as well as public confusion about how they should be applied to an individual's unique needs. The translation of guideline recommendations into plain language, however, may help improve public knowledge and awareness of the applications and implications of guidelines.

In a new paper published in the Journal of Clinical Epidemiology, Santesso and colleagues set out to develop a template for communicating guideline recommendations as well as explore public attitude around guidelines. First, the authors conducted semi-structured focus groups to gather information about general perceptions and opinions regarding guidelines. Then, these insights were used to develop a plain language template which was user-tested. The template was then revised into a final version. During the process, a few key themes emerged, including:

  • an upfront and clear description of the population/individuals to whom the guideline applies
  • a section detailing topics and questions to bring up with one's health care provider
  • definitions surrounding the strength of the recommendation, and further considerations for decision-making around conditional recommendations
  • formatting that makes use of bullets and tables rather than blocks of text

These themes informed the development of the final template, which includes six major items:
  1. the recommendation, its strength (with a symbol), and an explanation 
  2. the population/individuals to whom the recommendation applies
  3. rationale for the strength of the recommendation
  4. additional considerations when using the recommendation
  5. benefits and harms 
  6. implications, what a patient can do, and questions or topics to discuss with one's health care provider
Santesso, N., Wiercioch, W., Barbara, A.M., Dietl, H, and Sch√ľnemann, H.J. (2021). Focus groups and interviews with the public led to the development of a template for a GRADE plain language recommendation. J Clin Epidemiol, in-press.

Manuscript available at the publisher's website here