Clinical Practice Guidelines Should Include Patient’s Preferences

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Clinicians want to provide excellent patient care without having to appraise every new study in their field, but producing the “authoritative, instructive resource for most clinical scenarios” is not as straightforward as it would seem, according to David Garcia, MD, professor, University of Washington School of Medicine in Seattle.

At a special symposium on quality care and clinical practice guidelines during ASH, Garcia discussed the challenges of guideline development and emphasized the need to include the preferences of patients, whose lives are impacted by these guidelines.

“Our job is to apply evidence and guideline recommendations within the context of individual patient prefer­ences and values, and these can never be predicted or accounted for by people writing the guidelines,” he said.

Consider the Patients
The best guidelines are based on “strong evidence,” and the proper ingredients of a “strong recommendation” are 2-fold: the inclusion of high-quality evidence that proves the impact on important clinical outcomes, as opposed to surrogate outcomes that may not matter to the patient; and the demonstration that any risks associated with the intervention are clearly outweighed by benefits, he said.

“These seem obvious, but as physicians we may not always predict accurately what the patient sees as being worthwhile in terms of the risks they are willing to accept for the benefits we can offer,” Garcia said.

Future guideline writers need to focus on patient-important (not surrogate) outcomes whenever possible, he suggested, and to be equipped with better knowledge about how patients view the trade-offs associated with treatment options.

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