The aim of this study was to develop an educational video introducing an innovative panel survey approach to facilitate guideline panels in making inferences about patient values and preferences.

A user testing of the educational video through one-on-one interviews and iterative refinement of the video through brainstorming meetings.

Interviews and brainstorming meetings were conducted through Zoom.

The participants of the interviews include guideline panellists who had used the panel survey approach, and guideline panellists who had not used the approach but would or would not participate in a panel survey soon. The participants of the brainstorming meetings were a steering committee with expertise in guideline methodology and qualitative research.

The understandability and usefulness of the educational video.

We interviewed 18 guideline panellists from eight different guideline panels, all of whom carefully reviewed the video. Most participants found the video useful in explaining the panel survey approach and its role in incorporating patient values and preferences. Participants suggested improvements, including clarifying key concepts and using plain language instead of technical terminology to make the content more accessible. The major change the steering committee decided to make through brainstorming meetings was to add clarification, refine the wording and replace some text with animation.

User testing resulted in an improved educational video that is more useful and understandable for guideline panellists. Wider implementation of this resource has the potential to enhance the incorporation of patient values and preferences in guideline recommendations, supporting more patient-centred decision-making.

Healthcare professionals are increasingly burdened by clerical tasks, contributing to reduced job satisfaction, heightened burnout and potential risk for patient safety. Despite ongoing efforts to promote patient-centred care, direct interaction time with patients remains limited, affecting both professional fulfillment and the quality of patient experience. In response, hospitals have begun implementing structured programmes to enhance protected patient time, though their effectiveness remains uncertain. The Geneva University Hospitals (HUG) developed the ‘More Time at Patients’ Side’ (MTP) programme, integrating Lean management and Design Thinking principles to optimise clinical interactions. This study aims to evaluate an MTP booster intervention, designed to reinforce selected programme elements, using a cluster-randomised controlled trial focusing on patient pain management and healthcare professional job satisfaction.

The MTP Booster will be implemented in selected units at HUG across internal medicine, surgery, rehabilitation, palliative care and paediatrics units. Originally launched in 2017, the MTP programme introduced structured medical rounds, delegated clerical tasks and communication tools such as patient whiteboards. The booster intervention follows a stepped-wedge cluster-randomised design, with immediate reactivation in intervention units and delayed implementation in control units. The intervention consists of two key components: (A) a collaborative selection of MTP elements to reinforce, based on their feasibility and perceived usefulness and (B) structured integration of audit and feedback into daily routines, including on-site observations and staff training. The primary outcome is the quality of pain management, measured by the timely administration of analgesia. Secondary outcomes include pain documentation, patient satisfaction, healthcare professional work satisfaction, burnout levels, turnover risk and absenteeism. Other MTP-related audits are suspended during the study to preserve methodological integrity, and concurrent institutional initiatives will be documented as potential confounders.

The trial has a declaration of no objection by Swissethics (2024-00169). All final results will be reported in accordance with the Consolidated Standards of Reporting Trials extended for cluster-randomised trials. We intend to publish the results of this trial in an international peer-reviewed journal, irrespective of the results.

The trial is currently in the pre-results stage and is registered at ClinicalTrials.gov, ID: NCT06491797, 9 July 2024.

We aimed to assess usage and explore factors influencing the suitability of British Medical Journal (BMJ) Rapid Recommendations—a set of international guidelines meeting standards of trustworthiness—for adaptation and implementation, further defined as implementability.

Qualitative descriptive study with a multimethod approach.

We used citation screening and a survey to identify groups that had used any of a sample of 14 BMJ Rapid Recommendations in adoption, adaptation, de novo guideline development or implementation.

12 participants from a range of country income levels were interviewed, using semistructured interviews.

Interviews were analysed using thematic analysis to identify themes related to implementability of the guidelines. We compared these findings with those from a critical appraisal conducted using three different appraisal tools.

BMJ Rapid Recommendations are used in high-income, middle-income and low-income countries. We identified 33 instances of use. Our thematic analysis of the interviews uncovered 14 challenges to implementability, categorised under perceived trustworthiness, comprehensibility and practical relevance. The critical appraisals gave the BMJ Rapid Recommendations high scores on validity, but low scores on implementability and measurability. The challenges found in the interviews were generally corroborated by the appraisals, but the comparison also exposed tensions such as the complex interaction between methodological rigour and perceived credibility, the balance between novelty and compatibility with current practice, and the difficulty of offering globally applicable yet locally practical guidance.

Implementability challenges may limit effective use of international guidelines globally. Recognising and reflecting on tensions between rigour, credibility and contextual feasibility may help improve their uptake and value. The next phase of this research will explore strategies to enhance guideline implementability during their development.

Values and preferences are key determinants of optimal care, and variability in patient values and preferences often dictates differences in patient management. Clinicians’ views of patients’ values and preferences may differ across cultural aspects and stage of training, but the extent to which this is the case remains uncertain. One key value and preference issue is the trade-off between quantity and quality of life, and this issue is particularly prominent among patients with dementia. We therefore propose to investigate the extent to which physicians’ perceptions of optimal management for patients living with advanced dementia may differ due to cross-cultural factors and stage of medical training.

We will conduct a sequential explanatory mixed-methods study (QUAN -> qual). First, we will administer paper-based or electronic surveys during educational sessions, conferences and rounds to medical students, residents and physicians in ten countries, either in person or online. Following that, a qualitative inquiry, guided by the findings of the quantitative study and the principles of the interpretive description design, will inform an in-depth exploration of the predictive factors identified in the quantitative data analysis.

The Hamilton Integrated Research Ethics Board at McMaster University has approved this study (approval number 2024-17651). We will disseminate our findings in peer-reviewed publications and present results at conferences as oral and poster presentations.

Many clinical practice guidelines (CPGs) claim to use Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, but its implementation varies. This suggests that CPG developers, methodologists and users would benefit from an instrument to evaluate the extent to which CPGs adhere to GRADE approach. Such a structured instrument is currently unavailable. Accordingly, this study will develop an evaluation instrument for assessing guideline adherence to the GRADE approach, which we have named ‘GRADE-Check’. The goal is to target items to which CPGs fail to adhere and that potentially have serious consequences resulting in inaccuracies in certainty of evidence and inappropriate direction or strength of recommendations, thereby discriminating across CPGs in issues of importance.

The panel will include up to 25 individuals with specific knowledge and expertise, including experienced authors, educators and methodologists on CPGs methodology and GRADE approach from relevant organisations. The instrument will focus on the key elements of GRADE, aiming for clarity for GRADE experts and non-GRADE experts to apply. The development process for GRADE-Check will consist of the following five phases: (1) recruitment of a panel of GRADE experts; (2) development of objectives and scope for the development of GRADE-Check and criteria for item selection; (3) generation of candidate items through a literature review and panel consultation; (4) panellist discussion to construct the initial draft and extended explanation manual and (5) user testing.

This study has been approved by the Medical Ethics Committee of Zhongnan Hospital of Wuhan University (no. (2025047K)). Our research findings will be published in peer-reviewed journal articles and presented at academic conferences. Additionally, the dissemination plan will include considerations for the development of implementation manuals, a dedicated project website and training tools.