"Guidelines meet shared decision making. Happy ever after?"

Article type
Authors
Elwyn G1, Alper B, Trevena L, Agoritsas T
1The Dartmouth Institute for Health Policy and Clinical Practice
Abstract
Evidence-based medicine became relevant to all when guidelines were born and given special status, raising the stakes on how to summarise evidence from population-based research. But clearly, patients are not populations, they have quirks, opinions, stories to tell and preferences that cannot be predicted by asking for blood test results. Shared decision making, favourite granddaughter of patient-centred care from the hip 1970s, has met her match in guidelines, and they have been caught flirting, with the rumour of a few fights as they try to work out whether this is a fling or a thing. This goal of this session is to suggest the relevant questions that the advocates of guidelines and shared decision making may want to ask each other.

Topics

Format

Minutes (Cumulative)

Strange bedfellows - guidelines and shared decision making 

Goals and introductions by panel speakers

5 (5)

Speaking the same language

Glyn Elwyn

Guideline developers have a specific terminology, and although evolving, the words arose from a different perspective, based on deriving the certainty of effect for different groups of people. Shared decision making views the world as one where uncertainty reigns, and where the views of individuals has primary legitimacy and relevance, the more so when there are high degrees of equipoise among relevant options.

Speaker


Discussion

5

5 (15)

Guidelines - Patient decision aids? Is harmony possible?

Thomas Agoritsas

This is about the relationship between guidelines and patient decision aids - should be co-designed, part of the same development system? What examples do we have of success? Or is this just a paradigm clash?

Speaker

Discussion

10

5 (30)

Guidelines - What about preferences? What can we do?

Lyndal Trevena

Preference construction is complex. Are guidelines capable of containing these concepts or methods? Are these methods even necessary? What benefit do they bring? Is this where clinical expertise needs to step in?

Speaker

Discussion

8

7 (45)

Guidelines - What about goals?

Glyn Elwyn

Are patient goals more important than the outcomes that science suggests?

Speaker

Discussion

10

5 (55)

Back to language again

Brian Alper

The terminology suggested by GRADE is becoming dominant - but will it prohibit a relationship between guidelines and shared decision making? Can they be happy ever after?

Speaker

Discussion

8

7 (70)

Plenary discussion

Discussion

20 (90)