From Research to Evidence to Context: Implementing and Using Guidelines as Decision Aids to Personalise Care

  • Trisha DunningEmail author


  • Clinical guidelines represent the distillation of available evidence into recommendations—they are essentially a form of consensus.

  • Guidelines may not address important contextual issues for organisations or individuals.

  • Guidelines must be contextualised to relevant organisations, clinical situations and individual older people with diabetes to be useful.

  • Unless we ask the ‘right’ questions we are likely to miss contextual and other issues that are essential to personalised care.

  • It is necessary to identify the unique elements of an organisation or an individual’s life to consider context.

  • The Knowledge to Action framework can be used to implement guidelines in most practice settings/organisational context. Shared decision-making can help identify the person’s unique context.


  1. American Geriatrics Society (2015) Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63(11):2227–2246CrossRefGoogle Scholar
  2. Bayer Tadd (2006)Google Scholar
  3. Carmen K, Dardess P, Maurer M et al (2013) Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff 32(2):223–231CrossRefGoogle Scholar
  4. Caughey G, Pratt N, Barratt J et al (2017) Understanding 30 day re-admission after hospitalisation of older patients for diabetes: identifying those at greatest risk. Med J Aust 208(4):170–175CrossRefGoogle Scholar
  5. Chapman S (2017) What matters most to you? How decision aids help patients make better choices.
  6. Cheung Chips (2010)Google Scholar
  7. Corriere M, Minang L, Sisson S et al (2014) The use of clinical guidelines highlights ongoing educational gaps in physician’s knowledge and decision making related to diabetes. BMC Med Educ.
  8. Dunning T (2016) Assessing older people with diabetes in Australia. Prim Care Diabetes Soc Aust 1(4):115–120Google Scholar
  9. Dunning T, Savage S, Duggan N (2013a) A philosophical framework to guide care of older people with diabetes. Centre for Nursing and Allied Health Research and IDOP, MelbourneGoogle Scholar
  10. Dunning T, Savage S, Duggan N (2013b) The McKellar guidelines for managing older people with diabetes in residential and other care settings. Deakin University and Barwon Health, Geelong Centre for Nursing and Allied Health ResearchGoogle Scholar
  11. Field B, Booth A, Ilott I, Gerrish K (2014) Using the knowledge to action framework in practice: a citation analysis and systematic review. Implement Sci 9:172. PMCID: PMC4258036CrossRefPubMedPubMedCentralGoogle Scholar
  12. Glasgow R, Emmons K (2007) How can we increase translation of research into practice. Types of evidence needed. Annu Rev Public Health 28:413–433CrossRefPubMedGoogle Scholar
  13. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof 2006;26(1):13–24Google Scholar
  14. Graham I, Logrin J, Harrison MB et al (2006) Lost in translation: time for a roadmap? J Contin Educ Health Prof 26(1):13–20CrossRefPubMedGoogle Scholar
  15. Green W, Ottoson J, Garcia C, Hiatt R (2009) Diffusion theory and knowledge dissemination, utilisation and integration in public health. Annu Rev Public Health 30:151–174CrossRefPubMedGoogle Scholar
  16. Grenhalghh T, MacFarlane R, Bate F et al (2004) Diffusion of innovations in service organisations: systematic review and recommendations. Millbank Q 82(4):581–629CrossRefGoogle Scholar
  17. Harris J, Graue M, Dunning T et al (2015) Involving people with diabetes and the wider community in diabetes research: a realist review protocol. Syst Rev.
  18. International Diabetes Federation (IDF) (2013) Global guideline for managing older people with type 2 diabetes. Accessed July 2017
  19. Kadu M, Stolee P (2015) Facilitators and barriers to implementing the chronic disease model in primary care: a systematic review. BMC Fam Pract.
  20. Malterud (2001)Google Scholar
  21. Modern English–Old English dictionary. Accessed October 2017
  22. National Health and Medical Research Council (1995) Guideline for the development and implementation of clinical practice guidelines. Australian Publishing Service, CanberraGoogle Scholar
  23. Nugent Pam. Psychological distance in, April 28, 2013. Accessed 30 Oct 2017
  24. Stacey D, Higuchi KA, Menard P, Davies B, Graham ID, O’Connor AM. Integrating patient decision support in an undergraduate nursing curriculum: an implementation project. Int J Nurs Educ Scholarsh 2009;6:10.
  25. Starfield B (2011) Is patient-centred care the same as person-focused care? Permanete J 15(2):63–69Google Scholar
  26. Trope Y, Liberman N (2010) Construal-level theory of psychological distance. Psychol Rev 117(2):440CrossRefPubMedPubMedCentralGoogle Scholar
  27. Turner T, Misso M, Harris C, Green S (2008) Development of evidence-based clinical practice guidelines (CPGs): comparing approaches. Implement Sci.
  28. Weiner S (2004) From research to evidence to context: the challenge of individualizing care. Ann Intern Med 141(3):141–145Google Scholar
  29. World Health Organisation (WHO) (2017) WHO handbook of guideline development, 2nd edn. WHO, Geneva. Accessed Oct 2017
  30. WHO (2017b) Integrated care for older people. WHO, Geneva. Accessed Oct 2017Google Scholar
  31. WHO (2017c) WHO definition of palliative care. en/.Accessed July 2017

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Quality and Patient Safety Research, Barwon Health PartnershipDeakin UniversityGeelongAustralia

Personalised recommendations