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Adding "value" to clinical practice guidelines

Peter Loewen, PharmD
Regional Coordinator of Education and Research for Vancouver Coastal Health and Providence Health Care Pharmacy Services and is a Pharmacotherapeutic Specialist and an Associate Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia

Correspondence to: Dr James P. McCormack, Faculty of Pharmaceutical Sciences, 2146 East Mall, University of British Columbia, Vancouver, BC V6T 1Z3; telephone 604 603-7898; e-mail jmccorma{at}interchange.ubc.ca

OBJECTIVE To determine the degree to which current Canadian clinical practice guidelines (CPGs) for common chronic conditions (ie, diabetes, dyslipidemias, hypertension, and osteoporosis) discuss the importance of patients’ values and preferences in therapeutic decision making, and provide quantitative information that would allow for comprehensive shared informed decision making.

DESIGN Retrospective, observational review.

MAIN OUTCOME MEASURES The presence or absence of specific mentions of the importance of incorporating patients’ values and preferences into therapeutic decision making; the number and type (relative or absolute) of quantitative descriptions of benefit or harm; the number of interventions for which a means of quantitatively determining the probability that an individual patient will experience an end point without and with implementation of the therapeutic intervention; and the number of descriptions of specific or comparative costs of treatment.

RESULTS Three of 5 CPGs mentioned that patients’ values or preferences should influence treatment decisions. None of the CPGs recommended that benefits and harms of therapies be discussed with patients. Of the 63 quantitative mentions of therapeutic effects of interventions, 81%were presented using relative terms and 19% met our criteria for applicability to decision making for individual patients. Two of the 5 CPGs did not enumerate any harms. Three of the 5 CPGs made no mention of cost.

CONCLUSION Five prominent Canadian CPGs paid little attention to the issue of patients’ values and preferences in therapeutic decision making, even though these issues are fundamental tenets of evidence-based practice. These 5 CPGs provided limited quantitative information on benefits and harms and therefore could not be used by clinicians to truly involve patients in informed decision making.

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				A. Boivin, F. Legare, and M.-P. Gagnon Competing norms: Canadian rural family physicians' perceptions of clinical practice guidelines and shared decision-making J Health Serv Res Policy, April 1, 2008; 13(2): 79 - 84. [Abstract] [Full Text] [PDF]