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How can clinical practice guidelines be adapted to facilitate shared decision making? A qualitative key-informant study
  1. Trudy van der Weijden1,
  2. Arwen H Pieterse2,
  3. Marije S Koelewijn-van Loon1,
  4. Loes Knaapen3,
  5. France Légaré4,
  6. Antoine Boivin5,
  7. Jako S Burgers6,
  8. Anne M Stiggelbout2,
  9. Marjan Faber7,
  10. Glyn Elwyn7,8
  1. 1Department of General Practice, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
  2. 2Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
  3. 3Department of Social Studies of Medicine, McGill University, Montreal, Canada
  4. 4Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada
  5. 5Department of Family Medicine, Université de Sherbrooke, Longueuil, Canada
  6. 6Department of Clinical Practice Guidelines, Dutch College of General Practitioners, Utrecht, The Netherlands
  7. 7Department of IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  8. 8Department of Primary Care and Public Health, Cardiff University, Cardiff, UK
  1. Correspondence to Professor Trudy van der Weijden, Department of General Practice, CAPHRI School of Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht 6200 MD, The Netherlands; trudy.vanderweijden{at}


Background To explore how clinical practice guidelines can be adapted to facilitate shared decision making.

Methods This was a qualitative key-informant study with group discussions and semi-structured interviews. First, 75 experts in guideline development or shared decision making participated in group discussions at two international conferences. Next, health professionals known as experts in depression or breast cancer, experts on clinical practice guidelines and/or shared decision making, and patient representatives were interviewed (N=20). Using illustrative treatment decisions on depression or breast cancer, we asked the interviewees to indicate as specifically as they could how guidelines could be used to facilitate shared decision making.

Results Interviewees suggested some generic strategies, namely to include a separate chapter on the importance of shared decision making, to use language that encourages patient involvement, and to develop patient versions of guidelines. Recommendation-specific strategies, related to specific decision points in the guideline, were also suggested: These include structuring the presentation of healthcare options to increase professionals' option awareness; structuring the deliberation process between professionals and patients; and providing relevant patient support tools embedded at important decision points in the guideline.

Conclusions This study resulted in an overview of strategies to adapt clinical practice guidelines to facilitate shared decision making. Some strategies seemed more contentious than others. Future research should assess the feasibility and impact of these strategies to make clinical practice guidelines more conducive to facilitate shared decision making.

  • Clinical practice guidelines
  • Shared decision making
  • Quality improvement

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