Clinical practice guidelines for health professionals have become increasingly common. Originally conceived as a way to provide a synthesis of available evidence to clinicians, establish a more objective basis for decision making, and thus increase quality of care, they may also help to decrease gender, racial, or disease related bias in patient care, improve patient understanding and consent to treatment, and decrease costs by limiting unnecessary, suboptimal, or harmful treatment practices.
Despite all these benefits, many health professionals remain reluctant to advocate practice guidelines. A commonly raised argument is that they take away health professionals’ autonomy by prescribing “cookbook medicine.” However, guidelines are perforce high-level and cannot address every clinical variation. Guidelines are not intended to replace best clinical judgment, which can take into account all available information, including patient preferences. Nor should they ever become a rigid standard against which health professionals are judged.
In writing a guideline, the right balance between high level evidence-based recommendations, and tailoring to specific cases, needs to be achieved so that the guideline is concise enough to be readable, while not so vague as to be unusable. Careful choice of the questions and issues to be covered is important, so that they address the most important controversies of the day. Each additional question has resource implications, since systematic reviews are costly exercises. Inevitably, bias can creep in, both around question choice and interpretation of the evidence; careful selection of multidisciplinary team members with appropriate expertise on guideline committees, as well as open disclosure of potential conflicts of interest, are important, something done poorly in many published guidelines.
This presentation will explore these and other issues to consider when constructing guidelines.