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To the Editor: In their Commentary, Drs Krahn and Naglie¹ made a strong and compelling case for patients' preferences and values becoming an integral part of clinical practice guidelines. However, their contention that the focus of guidelines on evidence-based medicine (EBM) is responsible for a delay in making values and preferences prominent is contrary to the facts. In the Users' Guides to the Medical Literature, a series of articles published in JAMA beginning in 1993, the Evidence-Based Medicine Working Group championed the crucial role of patient preferences in clinical practice guidelines and in patient care.

In 1995, the Users' Guide for clinical practice guidelines² suggested as one of its validity criteria, "Was an explicit and sensible process used to consider the relative value of different outcomes?" and pointed out that "the relative importance of avoiding breast cancer or cardiovascular disease depends on what patients care about most."

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M. Hassan Murad, MD, MPH
murad.mohammad@mayo.edu
Division of Preventive, Occupational and Aerospace Medicine

Victor M. Montori, MD, MSc
Knowledge and Encounter Research Unit
Mayo Clinic
Rochester, Minnesota

Gordon H. Guyatt, MD, MSc
Department of Clinical Epidemiology and Biostatistics
McMaster University
Hamilton, Ontario, Canada

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The Next Step in Guideline Development: Incorporating Patient Preferences
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