Table 3.

Implications of approaches to guideline implementation that differ by onus of responsibility

Implications	Responsibility
	Developers	Intermediaries	Users
Pros	· Continuity with development	· Multiple mechanisms/roles:	· User demand for instructions and tools
	· There is no one else to implement guidelines	○ Advise on tailoring of implementation	· Lasting effect because instructions and tools always available once developed
		○ Influence peers as champions	· Feasible (easier, faster, least costly) so could be widely adopted
		○ Assist with implementation
Cons	· Insufficient resources are available with which to build capacity	· Clinicians most suitable intermediaries but not likely to volunteer	· Users have limited time to look at more information in guidelines
	· Better to engage users in development and implementation	· Resources needed to identify, compensate, train, and support them	· Resources needed to develop instructions and tools