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Table 2 Prenatal record committee processes for the introduction, interpretation and application of research evidence

From: Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study

Stages of evidence use Case 1 Case 2 Case 3 Case 4 Case 5
Introduction (Who supplied the research evidence?) PH/RCP coordinator, PRC members; expert consultants, researcher with RA support, clinician colleagues PH/RCP coordinator, expert consultants, individual PRC members PRC chair, PRC member with summer student support, expert consultants from Ministry of health PH/RCP coordinator, expert consultants, clinician colleagues 3-member PRC sub-committee, with librarian support
Interpretation (How was the quality of the research evidence appraised?) Use of evidence hierarchies to evaluate research evidence PRC members trusted the expertise of those supplying the research evidence; literature considered “high quality” if published in peer-reviewed journals and adopted by other jurisdictions Primary reliance on synthesized sources of evidence; PRC accepted research evidence as valid if integrated by other jurisdictions into their prenatal records PRC members trusted/assumed that each had expertise in evaluating research quality PRC members trusted the expertise of those supplying the research evidence
Interpretation (Who else was consulted for advice or feedback on proposed revisions to the prenatal records?) Other provincial perinatal agencies, substance abuse specialists, university researchers, public health specialists, clinicians selected to review proposed revisions Experts on specific topics (e.g., substance abuse), prenatal record committee members in other jurisdictions, clinician stakeholders via provincial professional groups, professional organizations represented on the committee, academics Clinician stakeholders (nurses, physicians, midwives), local native women’s councils, nurse management group, prenatal record members in other jurisdictions, Ministry of Health experts in health promotion and substance abuse, electronic record specialist Provincial perinatal advisory committee, colleagues from provincial tobacco and alcohol strategies, clinician stakeholders (nurses, nurse-practitioners, MDs, midwives) from across the province Suggestions for revisions solicited from obstetricians and GPs through provincial professional associations and university departments of medicine (obstetrics, pediatrics, family practice)
Application (How was final consensus on revisions to the prenatal record obtained?) Committee informally aimed for consensus; agreement to maintain a clinical focus as the priority; “bargaining” with final decisions based on consensus among members from the different physician groups, sometimes the “loudest voice wins”. Agreement that prenatal record needed to reflect “best practices”; negotiation of what worked best for the majority; commitment to persist with the review until everyone “can live with the product”. Agreement through “good discussion” until consensus was reached; seeking a compromise between needs of physicians, midwives and nurses (e.g., length of the form); physician dominance of the decision-making process. Consensus reached through discussion and then consulted widely outside the committee; established priorities to manage the volume of information collected for the review process; made “executive decisions” in the face of contradictory feedback from external consultations. Longstanding committee with high levels of mutual respect among members; consensus reached through discussion but “not everyone had to agree”; members may concede their opinion if a respected colleague felt strongly about a proposed revision.
  1. PH/RCP: provincial perinatal health/reproductive care program; RA: research assistant.