How Well Do Guidelines Incorporate Evidence on Patient Preferences?

Abstract

Clinical practice guidelines (CPG) are meant to consider important values such as patient preferences. To assess how well clinical practice guidelines (CPGs) integrate evidence on patient preferences compared with that on treatment effectiveness. A cross-sectional review of a listing in 2006 of CPGs judged to be the best in their fields by an external joint government and medical association body. Exclusion criterion was unavailability in electronic format. Sixty-five of 71 listed CPGs met selection criteria. Two instruments originally constructed to evaluate the overall quality of CPGs were adapted to specifically assess the quality of integrating information on patient preference vs. treatment effectiveness. Counts of words and references in each CPG associated with patient preferences vs. treatment effectiveness were performed. Two reviewers independently assessed each CPG. Based on our adapted instruments, CPGs scored significantly higher (p < 0.001) on the quality of integrating treatment effectiveness compared with patient preferences evidence (mean instrument one scores on a scale of 0.25 to 1.00: 0.65 vs. 0.43; mean instrument two scores on a scale of 0 to 1: 0.58 vs. 0.18). The average percentage of the total word count dedicated to treatment effectiveness was 24.2% compared with 4.6% for patient preferences. The average percentage of references citing treatment effectiveness evidence was 36.6% compared with 6.0% for patient preferences. High quality CPGs poorly integrate evidence on patient preferences. Barriers to incorporating preference evidence into CPGs should be addressed.