This project examined how three influential US medical journals present implications of research findings for practice. Most research reports provide a summary of the findings with a flat descriptive statement that a clinical outcome is better or worse with the tested intervention (68.6%). The one article that did not give this level of advice had findings that would not support doing so. Only about one-forth (25.5%) of the reports gave explicit recommendations for action and only one article provided instruction as to how to implement the recommended actions. The language in about half of the articles was tentative (47.1%) and a general call for further research was common (66.7%). Reporting in the three journals was generally similar, but as a group they differed from the management journals in including fewer calls to undertake action, and in not specifying who should act.
In this project we studied only a small sample of articles in a confined time frame, which limited the study's power and generalisability. Furthermore, our review did not examine editorials or journal review services, which often serve to put the findings of single studies into a broad context and provide substantial advice to the practitioner as to how to interpret the results.
While the target for implications for practice in medical journals was either not named or was specified only as ‘physicians’ or ‘clinicians’, the management journals virtually always named the target audience. Bartunek and Rynes identified more than 60 categories of individuals or groups to whom articles addressed their implications.1
The clinician audience for these medical journals may be so obvious as to need no specification.
The project raised some intriguing questions as to optimal reporting. In the management literature assessment, the authors advocated more statements of the implications for practice1
; in contrast, many of the articles we sampled from clinical literature had methodological limitations that precluded strong statements guiding practitioners towards changed practices. The findings could often have needed replication or could need to be weighed along with other considerations in making individual treatment decisions. Strong statements about medical practice might more often be justified in systematic reviews, or clinical practice guidelines based on extensive literature reviews. One well-known example is the US Preventive Services Task Force, which provides authoritative reviews and grades both the strength of the evidence and of their recommendations.60 61
However, clarity in assessing and reporting the impact of new findings is desirable, even when the report should have limited impact. Authors can clearly state what their work has added to the body of evidence and what its implications for practice are, even if the clearly stated advice would often be that a reasonable practitioner should not change anything yet. This proposal would operationalise for all research reports the contention of Clarke and Chalmers2
regarding randomised clinical trials. They advocated that each report should state, in the ‘discussion’ section, how the new findings reshape the prior body of evidence concerning the topic.
Editors should also consider undertaking formal tests of whether authors can clearly and succinctly state implications for practice, perhaps by providing explicit guidelines on grades of evidence and levels of recommendation and whether such explicit and consistent reporting helps readers. If past research and the new data support a strong recommendation for implementation, then the article should explicitly state the major counter-considerations or contingencies and often can provide ‘technical assistance’ for implementation. If the authors hold that the findings are not yet reliable enough for action, they could state that judgement clearly, along with their opinion regarding who should undertake what research or other actions.
Medical research generally builds in small increments and few articles make a dramatic difference to what practitioners should do. However, our findings suggest that the current system for reporting the implications of single clinical studies deserves serious re-examination by authors, editors and readers. Stating the strength of evidence and recommendations for action in those studies as directly, unambiguously and consistently as possible seems to us likely to prove helpful in translating their results into the most appropriate actions.