Adding "value" to clinical practice guidelines.

OBJECTIVE

To determine the degree to which current Canadian clinical practice guidelines (CPGs) for common chronic conditions (ie, diabetes, dyslipidemias, hypertension, and osteoporosis) discuss the importance of patients' values and preferences in therapeutic decision making, and provide quantitative information that would allow for comprehensive shared informed decision making.

DESIGN

Retrospective, observational review.

MAIN OUTCOME MEASURES

The presence or absence of specific mentions of the importance of incorporating patients' values and preferences into therapeutic decision making; the number and type (relative or absolute) of quantitative descriptions of benefit or harm; the number of interventions for which a means of quantitatively determining the probability that an individual patient will experience an end point without and with implementation of the therapeutic intervention; and the number of descriptions of specific or comparative costs of treatment.

RESULTS

Three of 5 CPGs mentioned that patients' values or preferences should influence treatment decisions. None of the CPGs recommended that benefits and harms of therapies be discussed with patients. Of the 63 quantitative mentions of therapeutic effects of interventions, 81%were presented using relative terms and 19% met our criteria for applicability to decision making for individual patients. Two of the 5 CPGs did not enumerate any harms. Three of the 5 CPGs made no mention of cost.

CONCLUSION

Five prominent Canadian CPGs paid little attention to the issue of patients' values and preferences in therapeutic decision making, even though these issues are fundamental tenets of evidence-based practice. These 5 CPGs provided limited quantitative information on benefits and harms and therefore could not be used by clinicians to truly involve patients in informed decision making.