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The Balance Between Rigor and Pragmatism

George P. Browman, MD

JAMA. 2001;286:1509-1511.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

As health care technologies, evidence-based practice, and clinical guidelines continue to evolve, so does understanding of their limitations.^1-3 The emphasis of the debate regarding evidence-based guidelines recently has shifted from the what to the how.⁴ Formal evaluations of guideline quality have called for improvements in their development.⁵ Guideline development represents an alloy of evidence, expert opinion, and the views and opinions of other stakeholders.⁶

The evidence-based method for guideline development is illustrated most compellingly and concretely through the fundamental difference in credibility (face validity) between the systematic review, which is at the heart of any evidence-based guideline, and the less rigorous narrative review of a body of scientific evidence.⁷ Accessing and analyzing evidence is the most expensive and time-consuming aspect of many evidence-based guideline development processes. The rigorous demands of the systematic review often cause guideline developers to revert to consensus- or expert-based models (eg, . . . [Full Text of this Article]

Author Affiliation: McMaster University and the Hamilton Regional Cancer Centre, Hamilton, Ontario, and Cancer Care Ontario, Toronto.

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