Introduction: In recent decades guideline recommendations have served as the standard for high-quality care. They aim to increase the quality, equity, and consistency of care and have probably provided some benefits to patient care. Nevertheless, by decreasing the clinician and patient autonomy and maintaining unrealistic assumptions of treatment benefits, they could fall short of reaching these goals and lead to worse individual choices and inefficiencies in healthcare (table 1). It is usually uncertain how well a recommendation represents patients’ values and preferences, therefore aiming for guideline-adherence, wastes limited healthcare resources and could make it more difficult to take care for patients who most need treatment.
An alternative: Replacing recommendations with short benefit/harm statements could be the next step towards evidence-based medicine (EBM) and sustainable healthcare. The statements would include the absolute benefits of benefits and harms for the patient important outcomes and if there are modifying factors for the effect.

Discussion:

An important part of EBM is acknowledging patients’ values and preferences. As guidelines rarely provide sufficient information on benefits and harms, it’s not surprising that shared decision-making is often lacking. Without the information, clinicians might not have other options than leaning to the outside authority of guidelines. This can be detrimental to the physician-patient relationship. Rather than seeking to persuade the patient about the recommended option, central to trust building and shared decision-making is informing about benefits and harms and supporting the patient’s autonomy. The lack of information also makes prioritization difficult. Recommendations may nudge clinicians toward treatments or tests that do not provide individual value considering the values and preferences. Similarly, patients who would have individual benefits, may not get treatment because of the recommendation judgment of too small benefit. With the benefit/harm statements, instead of nudging towards a ready-made choice, guidelines would nudge towards an informed decision, and value and preference-sensitive care.