ArticleBMJ open2019
Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
34 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Driving factors in treatment decision-making of patients seeking medical assistance for infertility: a systematic review.Human reproduction update · 2024Pooled it
- Patient engagement in perioperative settings: A mixed method systematic review.Journal of clinical nursing · 2023Pooled it
- Systematic review of shared decision-making in guidelines about colorectal cancer screening.European journal of cancer care · 2022Pooled it
- Mindfulness and Tai Chi for Sleep, Fatigue, and Pain in Distressed People After Cancer Treatment: A Partially Randomized Patient-Preference Comparative Effectiveness Trial.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026Trial
- Right out of the gate: a mixed method study on the needs and priorities of individuals with or at risk of breast cancer-related lymphedema.Journal of cancer survivorship : research and practice · 2026Article
- Shared Decision Making: Aids and Promotion in Clinical Practice Guidelines for Type 2 Diabetes Treatment.Journal of evaluation in clinical practice · 2026Article
- Patient preferences for analgesia in lung surgery: an observational cohort study.BMC anesthesiology · 2025Observational
- Critical Care Physicians' Perspectives on Nudging in Communication.JAMA network open · 2025Article
- Survival by Treatment Recommendation and Receipt Among Older Patients With Early-Stage Cervical Cancer.JAMA network open · 2025Article
- Patient experiences of shared decision-making following a displaced collarbone injury: A qualitative interview study.Clinical rehabilitation · 2025Article
- Curative intent therapy of stage I-III non-small cell lung cancer: a patient-centered precision approach to assess, measure, and interpret benefits and harms.Journal of thoracic disease · 2025Article
- Cancer Patients' Experiences of Burden when Involved in Treatment Decision Making.Medical decision making : an international journal of the Society for Medical Decision Making · 2025Article
- Medication Management in Patients With Polypharmacy in Primary Care: A Scoping Review of Clinical Practice Guidelines.Journal of evidence-based medicine · 2025Article
- Patient preferences and willingness to pay for transitional care in breast cancer: a discrete choice experiment.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Article
- Preferences for gene therapy in Duchenne muscular dystrophy: insights from patient and caregiver interviews and attribute development.Frontiers in pharmacology · 2025Article
- Prenatal diagnosis following preimplantation genetic testing for monogenic conditions: a single centre record linkage study.Journal of assisted reproduction and genetics · 2025Article
- Physician preferences of biomarker testing strategies in newly diagnosed stage IV non-small cell lung cancer patients.Future oncology (London, England) · 2024Article
- Fostering Shared Decision-Making Between Patients and Health Care Professionals in Clinical Practice Guidelines: Protocol for a Project to Develop and Test a Tool for Guideline Developers.JMIR research protocols · 2024Article
- Assessing patient information needs for new antidiabetic medications to inform shared decision-making: A best-worst scaling experiment in China.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Use of Persuasive Language in Communication of Risk during Prostate Cancer Treatment Consultations.Medical decision making : an international journal of the Society for Medical Decision Making · 2024Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveMany treatment decisions are preference-sensitive and call for shared decision-making, notably when benefits are limited or uncertain, and harms impact quality of life. We explored if clinical practice guidelines (CPGs) acknowledge preference-sensitive decisions in how they motivate and phrase their recommendations.
designWe performed a qualitative analysis of the content of CPGs and verified the results in semistructured interviews with CPG panel members.
settingDutch oncology CPGs issued in 2010 or later, concerning primary treatment with curative intent.
participants14 CPG panel members. MAIN OUTCOMES: For treatment recommendations from six CPG modules, two researchers extracted the following: strength of recommendation in terms of the Grading of Recommendations Assessment, Development and Evaluation and its consistency with the CPG text; completeness of presentation of benefits and harms; incorporation of patient preferences; statements on the panel's benefits-harm trade-off underlying recommendation; and advice on patient involvement in decision-making.
resultsWe identified 32 recommendations, 18 were acknowledged preference-sensitive decisions. Three of 14 strong recommendations should have been weak based on the module text. The reporting of benefits and harms, and their probabilities, was sufficiently complete and clear to inform the strength of the recommendation in one of the six modules only. Numerical probabilities were seldom presented. None of the modules presented information on patient preferences. CPG panel's preferences were not made explicit, but appeared to have impacted 15 of 32 recommendations. Advice to involve patients and their preferences in decision-making was given for 20 recommendations (14 weak). Interviewees confirmed these findings. Explanations for lack of information were, for example, that clinicians know the information and that CPGs must be short. Explanations for trade-offs made were cultural-historical preferences, compliance with daily care, presumed role of CPGs and lack of time.
conclusionsThe motivation and phrasing of CPG recommendations do not stimulate choice awareness and a neutral presentation of options, thus hindering shared decision-making.
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Registered trials
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