title: How well do guidelines incorporate evidence on patient preferences?
abstract: BACKGROUND
  Clinical practice guidelines (CPG) are meant to consider important values such as patient preferences.
  
  
  OBJECTIVE
  To assess how well clinical practice guidelines (CPGs) integrate evidence on patient preferences compared with that on treatment effectiveness.
  
  
  METHODS
  A cross-sectional review of a listing in 2006 of CPGs judged to be the best in their fields by an external joint government and medical association body.
  
  
  METHODS
  Exclusion criterion was unavailability in electronic format. Sixty-five of 71 listed CPGs met selection criteria.
  
  
  METHODS
  Two instruments originally constructed to evaluate the overall quality of CPGs were adapted to specifically assess the quality of integrating information on patient preference vs. treatment effectiveness. Counts of words and references in each CPG associated with patient preferences vs. treatment effectiveness were performed. Two reviewers independently assessed each CPG.
  
  
  RESULTS
  Based on our adapted instruments, CPGs scored significantly higher (p < 0.001) on the quality of integrating treatment effectiveness compared with patient preferences evidence (mean instrument one scores on a scale of 0.25 to 1.00: 0.65 vs. 0.43; mean instrument two scores on a scale of 0 to 1: 0.58 vs. 0.18). The average percentage of the total word count dedicated to treatment effectiveness was 24.2% compared with 4.6% for patient preferences. The average percentage of references citing treatment effectiveness evidence was 36.6% compared with 6.0% for patient preferences.
  
  
  CONCLUSIONS
  High quality CPGs poorly integrate evidence on patient preferences. Barriers to incorporating preference evidence into CPGs should be addressed.
authors.affiliation: Section of General Internal Medicine, Lakeridge Health Oshawa, 1 Hospital Court, Oshawa L1G 2B9, Canada. caky.chong@gmail.com
authors.forename: Christopher A K Y
authors.initials: CA
authors.lastname: Chong
authors.forename: Ing-je
authors.initials: IJ
authors.lastname: Chen
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn
mesh_terms: D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards*; D006801:Humans; D057240:Patient Preference; D017410:Practice Guidelines as Topic / Q000592:standards*