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Commentary |

The Next Step in Guideline Development:  Incorporating Patient Preferences

Murray Krahn, MD, MSc, FRCPC; Gary Naglie, MD, FRCPC
JAMA. 2008;300(4):436-438. doi:10.1001/jama.300.4.436.
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Clinical practice guidelines (CPGs) are systematically developed statements to assist both patient and practitioner decisions. A fixture of modern medical care, guidelines link the practice of medicine more closely to the body of underlying evidence, shift the burden of evidence review from the individual practitioner to experts, and aim to improve the quality of care.1

But do guidelines take into account what patients want and value? Consider the following examples. A patient with mild to moderate hypertension has shown some lowering of blood pressure but has not achieved her guideline-recommended target with salt reduction, exercise, and weight reduction. After considering the potential risks and benefits, she prefers to avoid drugs and continue with her behavioral interventions. Another patient with atrial fibrillation prefers to begin taking warfarin rather than aspirin, even though he is at low risk of stroke. He is a surgeon, and a stroke would be a career-ending event. Both of these patients have made what appear to be rational choices, but choices that are at odds with what guidelines2,3 recommend.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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