Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case.

Clicks: 412
ID: 68860
2019
Article Quality & Performance Metrics
Overall Quality
Not rated
Combines reader engagement with the AI quality analysis. This article has not been analysed, so there is no overall score — reader engagement is measured and shown alongside.
AI Quality Assessment
Not analyzed
Readership in this journal
Emerging

Ranked #43 of 442 articles by views in BMJ open

Most read Least read

Bar heights use a square-root scale. Only the 120 most-read articles are drawn; the journal has 442 in total.

Mint this article as an NFT
Not yet minted

Create a permanent, verifiable on-chain record of this article on the Scimatic Network. The NFT is held in your Journament account, and you can withdraw it to your own wallet at any time.

5 SUSD one-off · no wallet required
Sign in to mint
Abstract
Many treatment decisions are preference-sensitive and call for shared decision-making, notably when benefits are limited or uncertain, and harms impact quality of life. We explored if clinical practice guidelines (CPGs) acknowledge preference-sensitive decisions in how they motivate and phrase their recommendations.We performed a qualitative analysis of the content of CPGs and verified the results in semistructured interviews with CPG panel members.Dutch oncology CPGs issued in 2010 or later, concerning primary treatment with curative intent.14 CPG panel members.For treatment recommendations from six CPG modules, two researchers extracted the following: strength of recommendation in terms of the Grading of Recommendations Assessment, Development and Evaluation and its consistency with the CPG text; completeness of presentation of benefits and harms; incorporation of patient preferences; statements on the panel's benefits-harm trade-off underlying recommendation; and advice on patient involvement in decision-making.We identified 32 recommendations, 18 were acknowledged preference-sensitive decisions. Three of 14 strong recommendations should have been weak based on the module text. The reporting of benefits and harms, and their probabilities, was sufficiently complete and clear to inform the strength of the recommendation in one of the six modules only. Numerical probabilities were seldom presented. None of the modules presented information on patient preferences. CPG panel's preferences were not made explicit, but appeared to have impacted 15 of 32 recommendations. Advice to involve patients and their preferences in decision-making was given for 20 recommendations (14 weak). Interviewees confirmed these findings. Explanations for lack of information were, for example, that clinicians know the information and that CPGs must be short. Explanations for trade-offs made were cultural-historical preferences, compliance with daily care, presumed role of CPGs and lack of time.The motivation and phrasing of CPG recommendations do not stimulate choice awareness and a neutral presentation of options, thus hindering shared decision-making.
Reference Key
grtner2019rolebmj Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Gärtner, Fania R;Portielje, Johanneke E;Langendam, Miranda;Hairwassers, Desiree;Agoritsas, Thomas;Gijsen, Brigitte;Liefers, Gerrit-Jan;Pieterse, Arwen H;Stiggelbout, Anne M;
Journal BMJ open
Year 2019
DOI
10.1136/bmjopen-2019-032483
URL
Keywords
evidence-based medicine shared decision making patient preferences grade choice awareness protocols & guidelines

Citations

No citations found. To add a citation, contact the admin at info@scimatic.org

Comments

No comments yet. Be the first to comment on this article.