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.
Strange bedfellows - guidelines and shared decision making
Goals and introductions by panel speakers
Speaking the same language
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.
Guidelines - Patient decision aids? Is harmony possible?
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?
Guidelines - What about preferences? What can we do?
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?
Guidelines - What about goals?
Are patient goals more important than the outcomes that science suggests?
Back to language again
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?