Christopher Carroll argues that generic advice to share decision making is insufficient and that successful clinical guidelines need to reflect disease specific insights into patients’ experiences, views, beliefs, and priorities | BMJ
As Sackett and colleagues wrote 20 years ago, evidence based practice involves the use of the “best external evidence” to inform clinical decision making. The published evidence used to underpin clinical guidelines, including those produced by the National Institute for Health and Care Excellence (NICE) in the UK, is almost exclusively quantitative. This is understandable as the principal focus is efficacy and safety: the aim is to establish what works. However, Sackett and colleagues were also clear that clinical practice should take account of patients’ preferences.
This is currently achieved by patient involvement in the process and by using primary qualitative research, which uses techniques such as interviews to explore how and why patients make the decisions they do. But a synthesis of such qualitative research studies paints a rich, subtle, and useful picture of patients’ experience, views, beliefs, and priorities, and could improve the implementation of clinical guidelines.
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