• Linn Brandt, Per Olav Vandvik, Pablo Alonso-Coello, Elie A Akl, Judith Thornton, David Rigau, Katie Adams, Paul O'Connor, Gordon Guyatt, and Annette Kristiansen.
• Department of Internal Medicine, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway.
• BMJ Open. 2017 Feb 10; 7 (2): e011569.

ObjectivesTo investigate practicing physicians' preferences, perceived usefulness and understanding of a new multilayered guideline presentation format-compared to a standard format-as well as conceptual understanding of trustworthy guideline concepts.DesignParticipants attended a standardised lecture in which they were presented with a clinical scenario and randomised to view a guideline recommendation in a multilayered format or standard format after which they answered multiple-choice questions using clickers. Both groups were also presented and asked about guideline concepts.SettingMandatory educational lectures in 7 non-academic and academic hospitals, and 2 settings involving primary care in Lebanon, Norway, Spain and the UK.Participants181 practicing physicians in internal medicine (156) and general practice (25).InterventionsA new digitally structured, multilayered guideline presentation format and a standard narrative presentation format currently in widespread use.Primary And Secondary Outcome MeasuresOur primary outcome was preference for presentation format. Understanding, perceived usefulness and perception of absolute effects were secondary outcomes.Results72% (95% CI 65 to 79) of participants preferred the multilayered format and 16% (95% CI 10 to 22) preferred the standard format. A majority agreed that recommendations (multilayered 86% vs standard 91%, p value=0.31) and evidence summaries (79% vs 77%, p value=0.76) were useful in the context of the clinical scenario. 72% of participants randomised to the multilayered format vs 58% for standard formats reported correct understanding of the recommendations (p value=0.06). Most participants elected an appropriate clinical action after viewing the recommendations (98% vs 92%, p value=0.10). 82% of the participants considered absolute effect estimates in evidence summaries helpful or crucial.ConclusionsClinicians clearly preferred a novel multilayered presentation format to the standard format. Whether the preferred format improves decision-making and has an impact on patient important outcomes merits further investigation.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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