Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach
Por:
Zhang, Y, Coello, PA, Brozek, J, Wiercioch, W, Etxeandia-Ikobaltzeta, I, Akl, EA, Meerpohl, JJ, Alhazzani, W, Carrasco-Labra, A, Morgan, RL, Mustafa, RA, Riva, JJ, Moore, A, Yepes-Nunez, JJ, Cuello-Garcia, C, AlRayees, Z, Manja, V, Falavigna, M, Neumann, I, Brignardello-Petersen, R, Santesso, N, Rochwerg, B, Darzi, A, Rojas, MX, Adi, Y, Bollig, C, Waziry, R, Schunemann, HJ
Publicada:
2 may 2017
Resumen:
Background: There are diverse opinions and confusion about defining and including patient values and preferences (i.e. the importance people place on the health outcomes) in the guideline development processes. This article aims to provide an overview of a process for systematically incorporating values and preferences in guideline development.
Methods: In 2013 and 2014, we followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to adopt, adapt and develop 226 recommendations in 22 guidelines for the Ministry of Health of the Kingdom of Saudi Arabia. To collect context-specific values and preferences for each recommendation, we performed systematic reviews, asked clinical experts to provide feedback according to their clinical experience, and consulted patient representatives.
Results: We found several types of studies addressing the importance of outcomes, including those reporting utilities, non-utility measures of health states based on structured questionnaires or scales, and qualitative studies. Guideline panels used the relative importance of outcomes based on values and preferences to weigh the balance of desirable and undesirable consequences of alternative intervention options. However, we found few studies addressing local values and preferences.
Conclusions: Currently there are different but no firmly established processes for integrating patient values and preferences in healthcare decision-making of practice guideline development. With GRADE Evidence-to-Decision (EtD) frameworks, we provide an empirical strategy to find and incorporate values and preferences in guidelines by performing systematic reviews and eliciting information from guideline panel members and patient representatives. However, more research and practical guidance are needed on how to search for relevant studies and grey literature, assess the certainty of this evidence, and best summarize and present the findings.
Filiaciones:
Zhang, Y:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Coello, PA:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
CIBERESP IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Brozek, J:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
McMaster Univ, Dept Med, Hamilton, ON, Canada
Wiercioch, W:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Etxeandia-Ikobaltzeta, I:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Akl, EA:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Amer Univ Beirut, Dept Internal Med, Fac Hlth Sci, Beirut, Lebanon
Meerpohl, JJ:
Univ Freiburg, Med Ctr, Cochrane Germany, Fac Med, Freiburg, Germany
Univ Paris 05, Hop Hotel Dieu, Ctr Rech Epidemiol & Stat, Sorbonne Paris Cite,U1153,Inserm,Cochrane France, 1 Pl Parvis Notre Dame, F-75181 Paris 04, France
Alhazzani, W:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
McMaster Univ, Dept Med, Hamilton, ON, Canada
Carrasco-Labra, A:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Univ Chile, Fac Dent, Evidence Based Dent Unit, Santiago, Chile
Morgan, RL:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Mustafa, RA:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Univ Missouri Kansas City, Dept Internal Med, Dept Nephrol, Kansas City, MO 64110 USA
Univ Missouri Kansas City, Dept Biomed & Hlth Informat, Kansas City, MO 64110 USA
Riva, JJ:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
McMaster Univ, Dept Family Med, David Braley Hlth Sci Ctr, 100 Main St West,6th Floor, Hamilton, ON L8P 1H6, Canada
Moore, A:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
McMaster Univ, Dept Family Med, David Braley Hlth Sci Ctr, 100 Main St West,6th Floor, Hamilton, ON L8P 1H6, Canada
Yepes-Nunez, JJ:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Univ Antioquia, Sch Med, Medellin, Colombia
Cuello-Garcia, C:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Tecnol Monterrey Sch Med, Monterrey, Mexico
AlRayees, Z:
Minist Hlth, Riyadh, Saudi Arabia
Manja, V:
Vet Affairs Med Ctr, Dept Med, Div Cardiol, Buffalo, NY USA
SUNY Buffalo, Dept Internal Med, Buffalo, NY USA
Falavigna, M:
Hosp Moinhos de Vento, Porto Alegre, RS, Brazil
Univ Fed Rio Grande do Sul, Natl Inst Sci & Technol Hlth Technol Assessment, Porto Alegre, RS, Brazil
Neumann, I:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Pontificia Univ Catolica Chile, Dept Internal Med, Santiago, Chile
Brignardello-Petersen, R:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Santesso, N:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
Rochwerg, B:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
McMaster Univ, Dept Med, Hamilton, ON, Canada
Darzi, A:
Amer Univ Beirut, Dept Internal Med, Fac Hlth Sci, Beirut, Lebanon
Rojas, MX:
Pontificia Univ Javeriana, Dept Clin Epidemiol & Biostat, Bogota, Colombia
Adi, Y:
King Faisal Specialist Hosp & Res Ctr, Riyadh, Saudi Arabia
Bollig, C:
Univ Freiburg, Med Ctr, Cochrane Germany, Fac Med, Freiburg, Germany
Waziry, R:
Amer Univ Beirut, Dept Internal Med, Fac Hlth Sci, Beirut, Lebanon
Univ New South Wales, Kirby Inst, Sydney, NSW, Australia
Schunemann, HJ:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada
McMaster Univ, Dept Med, Hamilton, ON, Canada
Gold, Green Published
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