Where can I publish a scoping review protocol?
IntroductionGeneral practitioners (GPs) require evidence-based guidance to support patient care15. GPs have a unique role in society, practicing medicine in the context of the family and community6. GPs strive to use a patient centred approach to achieve shared decision making by integrating clinical evidence, clinical judgement, and patient priorities7,8. Show
There are differences internationally in healthcare systems and the cultural context in which GPs practice, but the role of the GP internationally has similarities in that GPs are primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness9 GPs in some countries have a gatekeeper role, authorising access to specialty care, hospital care, and some diagnostic tests10. Clinical practice guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users decisions about healthcare11. However, a review of 45 UK guidelines reported that many guideline recommendations were based on studies with little or no relevance to primary care12. GPs are more likely to use guidelines where the evidence is perceived to be applicable to primary care and where there has been GP input at the guideline development stage13. Internationally, GP professional organisations, as key GP opinion leaders, play a varied role in the clinical practice guideline ecosystem. First, in certain countries, GP professional organisations develop de novo clinical guidelines. For example, the Dutch College of General Practice (NHG) develop de novo clinical guidelines for GPs across a range of primary care presentations and commonly managed conditions14. Second GP professional organisations may be approached to endorse clinical practice guidelines developed by external organizations and groups15. Third, GP professional organisations may disseminate materials to GPs based on national or international guidelines as part of an adopt or adapt approach1618. While methodological guidance exists to support the process of adoption and adaption of guidelines, there is a need to have standardisation of this process to facilitate reproducibility and reduce duplication of effort. Time pressure and increased workload are established barriers to GP implementation of clinical guidelines and evidence19. GP professional organisations are well placed to support GPs to assimilate required evidence through the provision of easily accessible, high level clinical guideline summaries and evidence synopses. However what role, if any, GP organisations take in the dissemination of such evidence is unknown. This gap in the literature limits the ability of GP professional organisations to share both experience and expertise in how best to support GPs in their clinical decision making to support evidence-based patient care. The aim of this scoping review is to identify what evidence-based guidance is published by GP professional organisations internationally to support GPs in their clinical decision making. The objectives are i) to identify the topics covered, both clinical and non-clinical; ii) to review the methods used to develop evidence-based guidance and/or clinical guidelines and how these guidance documents are structured and, iii) to explore how evidence is disseminated to GPs. MethodsScoping review frameworkThis scoping review will follow the framework proposed by the Joanna Briggs Institute (JBI)2023. While, the overall conduct of the scoping review is informed by the JBI framework, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting of the scoping review24. As this is a scoping review it will be designed to identify the range of the evidence available and will be represented as a mapping of the identified data, without the act of synthesis or particular reference to methodological quality of relevant studies25. Stage 1: Identifying the research questionOverarching research question: What evidence-based guidance is published by general practice professional organisations to support GPs clinical decision making? Objectives: a. What are the content topics that the organisations are providing? b. What are the methods for developing these guides? c. What are the structures of the guides and how are they presented? d. How are these guides disseminated to GPs? Stage 2: Identifying the relevant studiesTable 1 contains the eligibility criteria for the scoping review. Articles will be included where they are an evidence-based guidance document or guideline produced by a national general practice professional organisation. These guidance documents must support GPs clinical decision making and patient clinical care and be published in the last 10 years for currency. No language restrictions will be applied. Table 1. Eligibility criteria for inclusion in the review.
Search strategyThe search strategy will identify both published and grey literature and will follow a three step strategy, as per JBI20. A copy of the search strategy is shown in Table 2. Table 2. Search strategy.
The first step, the limited search, will include searching two appropriate online databases (Medline and Embase). An analysis of the text words in the titles and abstracts of retrieved papers will be conducted, and of the index terms used to describe the articles. The second step will use all identified key words and index terms to perform a second search of all the following databases: Medline, Embase, Cochrane Library and Scopus to identify peer reviewed research papers relating to our aim. This step will be conducted with input from an information specialist. Thirdly, reference lists of included articles will be searched for additional relevant articles. We foresee specific limitations to the above search. Word searching of databases may be inherently problematic as guides may not be reported in peer reviewed publications only. Therefore, they may not be retrieved or matched by only using this search strategy. Also, there is considerable heterogeneity of the nomenclature associated with this search, for example, guides versus guidance versus clinical guidelines. We plan to overcome these limitations by supplementing the search with targeted GP professional organisation contacts. This will be completed by contacting key informants via a key informant survey in GP professional organisations, identified on the basis of the definition of general practice being used for the review and the role of the GP as a gatekeeper. Various avenues will be utilised to contact key informants including WONCA Europe contacts. Grey literature search will also include searching Guideline Central and Evidence Search. The final included studies for screening will be downloaded to a reference management software package (EndNote X9) and duplicates removed. Stage 3: Study selectionTitles and abstracts will be screened for inclusion against the inclusion criteria for the review (Table 1). For those that appear to meet the inclusion criteria, full text articles will be retrieved and screened against the inclusion criteria. Those articles that fulfil all the inclusion criteria will be included in the review. The above steps will be completed by two reviewers (EOB and SD). They will work independently initially and then come together to compare results. Any discrepancies will be resolved by consensus and if consensus is not reached will be referred to a third reviewer (EW). Studies that do not meet the inclusion criteria will be excluded. Reasons for the exclusion will be kept and presented as part of the flow diagram. The final search results will be outlined in a PRISMA flow diagram from the PRISMA-ScR statement, which will be accompanied by a narrative description of the process. Stage 4: Charting the dataThis scoping review is designed to identify the range of the evidence available and represent this as a mapping of the identified data, without the act of synthesis or with particular reference to methodological quality of relevant studies25. For data extraction the standardised template from the JBI methodology guidance for scoping reviews will be adapted for use20. Key information will be organised in categories based on data from organisational characteristics (evidence source details) e.g., name, country, role, and membership. Details extracted from the source of evidence; characteristics related to the methods (e.g. general description of the method of development), the clinical topics covered and approach to structure and presentation. Modes of dissemination will be recorded as well as implementation strategies. These will be classified and categorised to generate a map of the methods used internationally to develop evidence-based guides for general practitioners and a narrative synthesis conducted. As part of this process one reviewer will independently chart the data from the retrieved articles using the data charting form developed for this review (Table 3). The second reviewer will check a sample of 20% of the charted data. They will then discuss the results and update the data charting form in an iterative process. Reasons for changes will be outlined and presented as an appendix as part of the review. If there are any inconsistencies these will be reviewed by a third reviewer. Table 3. Data charting form.
Stage 5: Collating, summarising and reporting of resultsResults will be reported using the PRISMA-ScR guidelines24. Each research question will be reported separately and presented in a tabular form and as a narrative summary. This narrative description will be used to synthesise the study findings based on themes that are generated from the extracted data. DisseminationWe intend to disseminate the results through publication in a peer-reviewed journal and conference presentations. Study statusDatabase searches have been completed and title and abstract screening is currently underway. EthicsEthical approval is not required for this scoping review. DiscussionThis scoping review will provide an overview of the evidence-based guidance produced and disseminated by GP professional organisations internationally. This scoping review can contribute to the evidence base for supporting GPs clinical decision making to benefit patient care. The findings of this scoping review will inform future research on the content, presentation dissemination and implementation of evidence-based guidance for GPs. Data availabilityNo data are associated with this article. |
