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XVII. How to Use Guidelines and Recommendations About Screening

Alexandra Barratt, MBBS, MPH, PhD; Les Irwig, MBBCh, PhD; Paul Glasziou, MBBS, PhD; Robert G. Cumming, MBBS, MPH, PhD; Angela Raffle, BSc (Hons), MBChB; Nicholas Hicks, MA, BMBCh; J. A. Muir Gray, CBE, MD; Gordon H. Guyatt, MD, MSc; for the Evidence-Based Medicine Working Group

JAMA. 1999;281:2029-2034.

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

CLINICAL SCENARIO

You are a family physician seeing a 47-year-old woman and her husband of the same age. They are concerned because a friend recently found out that she had bowel cancer and has urged them both to undergo screening with fecal occult blood tests (FOBTs) because, she says, prevention is much better than the cure she is now undergoing. Both your patients have no family history of bowel cancer and no change in bowel habit. They ask whether you agree that they should be screened.

You know that trials of FOBT screening have demonstrated that screening can reduce mortality from colorectal cancer (CRC), but you also . . . [Full Text of this Article]

THE SEARCH

INTRODUCTION

ARE THE RECOMMENDATIONS VALID?

Is There RCT Evidence That Earlier Intervention Works?

Were the Data Identified, Selected, and Combined in an Unbiased Fashion?

WHAT ARE THE RECOMMENDATIONS AND WILL THEY HELP YOU IN CARING FOR YOUR PATIENTS?

What Are the Benefits?

What Are the Harms?

How Do Benefits and Harms Compare in Different People and With Different Screening Strategies?

What Is the Impact of People's Values and Preferences?

What Is the Impact of Uncertainty Associated With the Evidence?

What Is the Cost-effectiveness?

RESOLUTION OF THE SCENARIO

Author Affiliations: Department of Public Health and Community Medicine, University of Sydney, Australia (Drs Barratt, Irwig, and Cumming); Department of Social and Preventive Medicine, University of Queensland, Herston, Australia (Dr Glasziou); Avon Health Authority, Bristol, England (Dr Raffle); Oxfordshire Health Authority, Oxford, England (Dr Hicks); Institute of Health Sciences, University of Oxford, England (Dr Gray); and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Dr Guyatt).

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