How Can We Help?
Translating guidelines
New information in medicine accrues at an extra-ordinary rate, with some estimates placing the half-life of medical knowledge at three to five years. For instance a 2007 review of systematic reviews found that they needed updating on average after 5.5 years. About 15% needed updating after one year.1 A similar study found that NICE guidelines had a median lifespan of 60 months2
The influences on actually making a decision are multiple, and guidelines are just one component of this:
So if information is changing so fast, and we want to be up to date, on the assumption that not being up to date leads to suboptimal care, then how does one go about it? The hard truth is that we are always going to be a bit out of date as we balance topicality against believability – as you move to more recent evidence, the chance that fresh information is correct becomes less secure. Do you only work from published randomised controlled trials? Would you treat based on findings in a non-peer-reviewed pre-print? What about a press release? Going the other way, it usually takes months to years to process information into systematic reviews, and clinical guidelines based on this level of evidence is another few years behind, so working with high quality clinical guidelines may still mean using information that is quite old, and potentially about to change, although in the trade between durability and believability, the balance is now more in favour of the former.
The less discussed issue is not whether information we use is always correct, but how often it leads to patient-relevant changes in management. The sad reality is that it nearly always does.
The other very real problem is that high quality guidelines are often very time-consuming to read. They contain valuable information, but 100+ pages on a single topic is almost equivalent to reading a short book on the subject. Picking out what is clinically relevant when in a rush is seldom easy, and even with new methods of information presentation, it is always possible that core components are missed.
Knowledge translation aims to bridge that gap. The idea is to pre-digest high quality information, and package it for targetted audiences. These may differ considerably, making that process complex for the actual guideline developers and easier fro individuals working in a particular health care environment.
Shojania KG, Sampson M, Ansari MT, Ji J, Doucette S, Moher D. How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med. 2007 Aug 21;147(4):224-33. doi: 10.7326/0003-4819-147-4-200708210-00179. Epub 2007 Jul 16. PMID: 17638714. ↩
Alderson LJ, Alderson P, Tan T. Median life span of a cohort of National Institute for Health and Care Excellence clinical guidelines was about 60 months. J Clin Epidemiol. 2014 Jan;67(1):52-5. doi: 10.1016/j.jclinepi.2013.07.012. Epub 2013 Oct 16. PMID: 24139089. ↩