The Art and Science of Guidelines: Navigating Decision-making with Clarity

Guidelines: Recommendations or standards based on research and evidence to guide decision-making.

In a world swamped with information, guidelines stand as beacons, illuminating our path with recommendations and standards rooted in meticulous research and evidence. But the question beckons, are these guidelines replicable and resilient, or are they susceptible to the whims of individual expert opinions?

Thus, let’s dive into the fluid space between evidence and expertise in the crafting of guidelines.

The Duality of Guidelines: Evidence and Opinion

Guidelines are intended to translate dense forests of evidence into accessible pathways of recommendations. They promise replicability, ensuring that different expert panels, when presented with the same evidence, would carve out identical recommendations. However, the discordance among guidelines, such as those observed in cholesterol guidelines, suggests that expert opinion plays a pivotal role alongside evidence in sculpting recommendations¹.

Incorporating Qualitative Research: A Symphony of Voices

An intriguing approach to guideline development is the integration of qualitative research. For instance, in constructing guidelines for family-centered care in ICUs, qualitative research was not just considered but explicitly incorporated to establish domains and outcomes for family-centered care². This approach provided a richer tapestry of insights, accounting for the multifaceted human experiences that quantitative data might overlook.

Judgement in Decision Making: Unveiling the Process

The process of decision-making during guideline development, while central, is often shrouded in mystery. A study exploring the crafting of disease prevention guidelines by the National Board of Health and Welfare in Sweden discovered that groups grapple with dilemmas, modify models ad-hoc, and add new decision criteria as they navigate through the process³. This highlights the need for guideline development models to be both rigorous and agile, providing clarity without sacrificing the flexibility to adapt to the intricacies of real-world decision-making.

Quality Over Quantity: A Call for Brevity and Rigor

Interestingly, as guidelines grow longer, there seems to be an increase in recommendations based on lower levels of evidence⁴. This paradox underscores the imperative for guideline developers to embrace brevity and adhere strictly to evidence-based principles. Each additional page should not dilute the potency of the evidence but rather distill it into clearer, actionable insights.

Guiding Questions:

• How does your organization navigate between the rigors of evidence and the nuances of expert opinion in developing guidelines?
• Have you considered the value of qualitative research in crafting richer, more empathetic guidelines?

A Call to Action: Embrace the Fluid Space

Guidelines are not monoliths; they are dynamic entities, shaped and reshaped by the ebb and flow of evidence and expertise. In creating guidelines:

1. Recognize that evidence and expertise are partners, not adversaries. Embrace their dance, and understand that each plays a crucial role in crafting guidelines that are both robust and relevant.
2. Qualitative research provides depth and texture to the tapestry of guidelines. Engage with it, and allow it to inform and enrich your guidelines.
3. Brevity is not the enemy of comprehensiveness. Strive for guidelines that are concise yet complete, clear yet comprehensive.
4. Embark on a journey where guidelines are not mere checklists but living documents, evolving with each step we take in understanding evidence and respecting expertise.

References:

1. Sniderman, A., Furberg, C., Toth, P., & Thanassoulis, G. (2015). Is the Guideline Process Replicable and, if Not, What Does This Mean?. Progress in cardiovascular diseases, 58 1, 3-9 . https://doi.org/10.1016/j.pcad.2015.05.002.
2. Coombs, M., Davidson, J., Nunnally, M., Wickline, M., & Curtis, J. (2017). Using Qualitative Research to Inform Development of Professional Guidelines: A Case Study of the Society of Critical Care Medicine Family-Centered Care Guidelines. Critical Care Medicine, 45, 1352–1358. https://doi.org/10.1097/CCM.0000000000002523.
3. Sundberg, L., Garvare, R., & Nyström, M. (2017). Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare. BMC Health Services Research, 17. https://doi.org/10.1186/s12913-017-2277-1.
4. Baird, A., & Lawrence, J. (2014). Guidelines: is bigger better? A review of SIGN guidelines. BMJ Open, 4. https://doi.org/10.1136/bmjopen-2013-004278.