Let Evidence Guide Every New Decision (LEGEND): An Evidence Evaluation System for Point-Of-Care Clinicians and Guideline Development Teams

J Eval Clin Pract. 2009 Dec;15(6):1054-60. doi: 10.1111/j.1365-2753.2009.01314.x.


Objective: To develop tools for use by teams of point-of-care clinicians to improve access to evidence evaluation.

Method: A search of the literature was conducted to review available evidence evaluation systems for their applicability to the project. Fourteen systems were reviewed in depth for strengths and limitations of the systems to meet the objective. Using these strengths and addressing the limitations, tools were developed and pilot-tested among an interprofessional team of clinicians. Results Five principles were drawn from the review of the literature and from our experience to guide development of six tools. The tools form a comprehensive evidence evaluation system known as Let Evidence Guide Every New Decision (LEGEND). LEGEND included a glossary, a table of evidence levels, an algorithm, a set of evidence appraisal forms, and worksheets to guide grading a body of evidence and judging the strength of a recommendation.

Conclusion: LEGEND provides tools for point-of-care clinicians that assist them in synthesizing evidence from published studies. The tools provide a balance between quality processes and simplicity, use terminology friendly to multiple disciplines, assist comprehensively with the evidence evaluation process, incorporate factors familiar to the user, and provide flexibility for a diverse range of evidence evaluation projects and users.

MeSH terms

  • Algorithms
  • Decision Support Systems, Clinical*
  • Evidence-Based Medicine*
  • Humans
  • Practice Guidelines as Topic*
  • Quality Assurance, Health Care
  • Research Design
  • Review Literature as Topic