Page 92 - Shared Guideline Development Experiences in Fertility Care

Chapter 4
in this eld but also had certain limitations. First, based on the results of a recent systematic review from Gagnon and colleagues [56], we acknowledge that the items used in our evaluation questionnaire might be incomplete. However, the results of our study add to those from the limited number of previously published studies on patients’ facilitators of and barriers to adoption of eHealth applications [57,58]. Second, the heuristics used were not based on a validated questionnaire and were too limited for drawing conclusions on the usability that patients perceived. erefore, a next step in future development of a wiki-based participatory tool for patients in CPG development should be to include a broader evaluation of the potentially in uencing factors on adoption, including more organizational factors and a heuristic evaluation.
ird, the participation rate in the evaluation of the wiki might have subjected our study to a participation bias of potentially the most motivated wiki users. However, this is a known limitation in the active use of wikis in general: the most motivated users provide most of the content [19]. Finally, this feasibility study did not assess the representativeness of either the participants or the nal set of recommendations in the wiki.
Conclusions
e wiki is a promising and feasible tool to actively involve patients in CPG development. To improve the tool’s ease of use and practical aspects to enhance direct integration of recommendations into the CPG, a more specialized and re ned wiki should be developed. is should include new modalities, such as automatically shortening the number and length of recommendations, using a xed format for formulation of recommendations, using a continuous prioritization system for selection of the most important recommendations, and including a separate motivation page. Furthermore, in the development, attention should be paid to the informational character of such a wiki. To improve future implementability, a modi ed tool should preferably be codeveloped and evaluated by patients in a user-centred design study. Furthermore, representativeness of patients and recommendations should be integrated into this next phase.
Abbreviations: AGREE, Appraisal of Guidelines Research and Evaluation; CPG, clinical practice guideline; GLIA, Guideline Implementability Appraisal
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