The study examined a knowledge translation initiative in which patients, caregivers, clinicians, and experts in evidence-based medicine jointly prioritized and framed evidence-based recommendations, or EBRs. From a pool of 527 candidate recommendations, the participatory process distilled 40 that were then disseminated to clinicians through one-way channels: printed materials, email, mobile messages, and web-based platforms. What made the initiative unusual was its upstream design. Rather than simply pushing guidelines at clinicians, the project invited the people who would ultimately live with the consequences of clinical decisions—patients and their caregivers—to help decide which evidence mattered most and how it should be presented.

One year after this dissemination campaign, the research team conducted 22 semi-structured interviews with 13 clinicians recruited through purposive sampling across primary, secondary, and tertiary healthcare settings. Data collection ran from February to June 2023, and the team analyzed the transcripts thematically using Braun and Clarke’s well-established approach, a method that involves systematic coding of interview data and iterative refinement of themes until a coherent explanatory framework emerges. The researchers followed the Consolidated Criteria for Reporting Qualitative Research, or COREQ, to ensure transparent reporting, and the study received ethics approval from the District Department of Health of Bogotá with written informed consent from all participants.

The good news is that the recommendations worked, at least in the ways dissemination campaigns typically promise. Clinicians described the materials as accessible and educationally valuable. They reported that the recommendations reinforced evidence-informed prescribing, sharpened diagnostic reasoning, and bolstered clinical confidence. In a health system where keeping pace with the research literature is a chronic challenge, materials that clinicians actually read and remember represent a genuine achievement. The participatory framing appears to have made the evidence more digestible and more relevant to the conditions clinicians encounter daily, particularly in the management of non-communicable diseases such as chronic obstructive pulmonary disease, where long-term care decisions depend heavily on individual circumstances.

But the study’s central finding lies in what did not happen. The patient- and caregiver-relevant elements embedded in some of the recommendations—the parts that reflected what patients and families had said mattered most—were used more often for information provision, adherence counselling, and patient education than for the explicit consideration of individual preferences during clinical decision-making. In other words, clinicians absorbed the patient-informed content and then deployed it as a communication tool, telling patients what to do and explaining why, rather than opening a genuine two-way deliberation about what the patient actually wanted. The preferences of patients and caregivers became content for the consultation rather than a force shaping the decision itself.

This distinction matters because it gets to the philosophical heart of evidence-based medicine. Patient preferences are not supposed to be an afterthought appended to a technically correct decision; they are meant to be one of the three pillars on which every clinical decision rests. A recommendation can carry patient voices in its very wording, yet if the clinician uses it primarily to persuade rather than to deliberate, the participatory promise remains unfulfilled. The study’s title says it plainly: making research evidence usable is not enough. Usability, it turns out, is a property of the evidence, while responsiveness is a property of the system.

Why did patient and caregiver priorities fail to penetrate the decision-making moment? The clinicians’ accounts pointed to a cluster of health system conditions that constrained how recommendations could be applied. Restricted consultation time was a recurring theme—when a clinician has minutes rather than quarters of an hour, the conversational space needed to elicit and weigh individual preferences is the first casualty. Administrative authorization requirements added another layer of friction, forcing clinicians to navigate bureaucratic gatekeeping before certain care could proceed. Fragmented care, in which patients move between providers and settings without continuity, made it harder to build the relationships through which preferences are naturally surfaced. And socioeconomic barriers meant that for many patients, the feasible options were narrower than the recommended ones, complicating any attempt to align care with what patients would genuinely choose.

These findings carry a pointed lesson for the growing field of participatory knowledge translation. Involving patients and caregivers in selecting and framing recommendations is a meaningful advance over traditional top-down guideline development, and the Bogotá initiative demonstrates that such involvement is feasible at scale. Yet the study shows that upstream participation, however well designed, cannot by itself guarantee that patient priorities inform clinical decisions downstream. Dissemination through one-way channels—however many channels are used—delivers information but does not create dialogue. Without ongoing implementation support, the patient-informed elements of recommendations risk being repurposed as counselling scripts rather than decision inputs.

The implications reach well beyond Colombia. Health systems worldwide are investing in patient and public involvement, from co-production of guidelines to patient advisory boards, and the assumption often implicit in these efforts is that participation at the design stage will translate into person-centred care at the bedside. This study complicates that assumption with empirical specificity. It suggests that participatory knowledge translation must be paired with structural interventions: protecting consultation time, streamlining administrative processes, strengthening continuity of care, and addressing the socioeconomic constraints that narrow patients’ real choices. Otherwise, the voices of patients and caregivers are heard clearly in the boardroom and lost in the consulting room.

For clinicians, the study is less an indictment than a mirror. The interviewed clinicians valued the recommendations and used them, which is more than many dissemination campaigns can claim. The gap identified here is not one of willingness but of capacity—a system that asks clinicians to practise shared decision-making while rationing the time, continuity, and autonomy that such practice requires. The researchers conclude that disseminating patient- and caregiver-informed recommendations through one-way channels makes a useful but insufficient contribution: it can make patient priorities available to clinicians and support evidence-informed practice, but it does not by itself ensure those priorities shape decisions. Closing that gap, they argue, requires tackling the health system barriers that constrain the use of patient and caregiver preferences in evidence-based medicine. In the end, the study delivers a deceptively simple message with profound consequences: evidence can be made usable by design, but making care responsive to the people it serves requires changing the conditions under which decisions are made.

Subject of Research: How clinicians use patient- and caregiver-informed evidence-based recommendations in routine care

Article Title: Making research evidence usable is not enough: clinicians’ use of patient- and caregiver-informed evidence-based recommendations in routine care—a qualitative study

Article References: Vergel, J., Martínez-Montoya, S., Casallas-Murillo, A.-L., Laverde-Robayo, D.-M., Torres-López, L.-A., & Parra-Beltrán, L. (2026). Making research evidence usable is not enough: clinicians’ use of patient- and caregiver-informed evidence-based recommendations in routine care—a qualitative study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15567-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15567-y

Keywords: evidence-based medicine, knowledge translation, patient preferences, caregivers, clinical decision-making, qualitative research, health system barriers, evidence-based recommendations, participatory prioritization, non-communicable diseases, health services research, shared decision-making