Although clinical guidelines are based on the best evidence available, their
proliferation has often failed to change actual practice. One of the many
explanations suggested is that there is a gap between the expectations of the
targeted professionals and the recommendations in the guidelines. In this
study, we attempted to take into account the state of current practice and
the physicians' priorities. Using the example of guidelines on the management
of thyroid nodules, three different surveys have been conducted:
(1) an analysis of physicians' expectations and practice through a postal
questionnaire to define appropriate questions; (2) a survey of the professionals'
expert opinions, and (3) a prospective study of the use of these
guidelines in the management of 253 patients. The results of these surveys
have modified the development of the guidelines, and helped us to adapt
the content of the guidelines to match physicians' practices more closely.