Fukuda 2009.

Methods	Study design: ITS
Participants	Physicians Clinical speciality: surgery Level of training: fully trained Setting/country: hospital/inpatient/Japan
Interventions	The PEM consisted of evidence‐based clinical practice guidelines for treatment of early‐stage breast cancer in Japanese women published in July 1999. The guidelines recommended breast‐conserving surgery followed by radiotherapy for the majority of women with Stage I or II breast cancer
Outcomes	1 process outcome: rate of use of breast‐conserving surgery (adjusted odds ratios of receiving breast‐conserving surgery in patients with breast cancer)
Notes	‐
Risk of bias
Bias	Authors' judgement	Support for judgement
Intervention independent of other changes ‐ ITS	Low risk	Quote, pg. 373: "because of language barriers, several large clinical trials published in Western countries seemed to have less impact on knowledge of the effectiveness of BCS in Japan compared with the impact in English‐speaking countries. Before the publication of the Japanese guideline, therefore, it was possible that Japanese women might be unaware of this treatment choice"  COMMENT: the authors make an argument that a language barrier (Japanese/English) may have limited passive dissemination from other countries
Shape of Intervention effect pre‐specified ‐ ITS	Unclear risk	Quote, pg. 373: "the aim of this study was to evaluate whether publication of clinical guidelines was associated with a change of treatment practices for breast cancer patients through the use of secondary administrative data from Japanese hospitals"
Intervention unlikely to affect data collection ‐ ITS	Low risk	The intervention (evidence‐based clinical practice guidelines) did not affect either the source or method of data collection
Blinding of outcome assessors (detection bias) ‐ ITS All outcomes	Low risk	The outcome was objective
Incomplete outcome data (attrition bias) ‐ ITS All outcomes	Low risk	The complete database of 10 teaching hospital in Japan was used for the study
Selective reporting (reporting bias) ‐ ITS	Low risk	All relevant outcomes in the methods section were reported in results section
Other bias ‐ ITS	Low risk	There was no evidence of other risks of bias