Patients and Clinical Practice Guidelines Development

The standard definition of clinical practice guidelines explicitly states their aim as “to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”.1 Over the past several years, the goal of allowing patients direct involvement in managing their health care has been pushed to the forefront, with the emphasis on shared decision-making2 and patient-centered care.3 The old paternalistic model of unassailable physician-directed recommendations is no longer a tenable approach.4 Patients are expected to understand the reasons for and consequences of the procedures they undergo and the care they receive to be able to decide between alternatives when available. Therefore, clinical practice guidelines, especially versions specifically designed for patient understanding, serve a valuable function in providing the information required for this informed decision-making.5The implications of using guidelines recommendations as a vehicle for shared decision-making between caregiver and patient are both subtle and profound. If the guideline recommendations reflect only the judgments of a set of expert professionals, do they reflect the sum of the factors that should be considered in advancing those recommendations? Although the goal of any experts developing guidelines is to use the best available evidence in deriving recommendations, physicians recognize that the results of even high-powered clinical trials must be subjected to expert evaluation to ensure proper interpretation and that the results are congruent with other values and practical considerations.6 In the Ottawa Practice Guidelines Development Cycle, evidence-based recommendations derived by a panel of experts are sent to a broad range of practitioners for...

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Rodger J. Winn is the Editor-in-Chief of JNCCN. His past positions include Associate Professor of Clinical Medicine at the University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.
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