The Next Step in Guideline Development
Incorporating Patient Preferences
- Murray Krahn, MD, MSc, FRCPC;
- Gary Naglie, MD, FRCPC
- Author Affiliations: Toronto Hospital (Dr Naglie); Toronto Health Economics and Technology Assessment Collaborative, Toronto General Research Institute, and University of Toronto (Dr Krahn), Toronto, Ontario, Canada.
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- DECISION MAKING
- EVIDENCE-BASED MEDICINE
- PATIENT SATISFACTION
- PATIENT-CENTERED CARE
- PRACTICE GUIDELINES AS TOPIC
- PROSTATIC NEOPLASMS
- PROSTATE-SPECIFIC ANTIGEN
Clinical practice guidelines (CPGs) are systematically developed statements to assist both patient and practitioner decisions. A fixture of modern medical care, guidelines link the practice of medicine more closely to the body of underlying evidence, shift the burden of evidence review from the individual practitioner to experts, and aim to improve the quality of care.1
But do guidelines take into account what patients want and value? Consider the following examples. A patient with mild to moderate hypertension has shown some lowering of blood pressure but has not achieved her guideline-recommended target with salt reduction, exercise, and weight reduction. After considering the potential risks and benefits, she prefers to avoid drugs and continue with her behavioral interventions. Another patient with atrial fibrillation prefers to begin taking warfarin rather than aspirin, even though he is at low risk of stroke. He is a surgeon, and a stroke would be a career-ending …
