Why consider patients' preferences? A discourse analysis of clinical practice guideline developers.
BACKGROUND
Several organizations are advocating for patients' preferences to be considered in clinical practice guideline development and implementation. However, lack of agreement on the goal and meaning of this policy curtails evaluation and development of patient involvement programs.


OBJECTIVE
To describe guideline developers' discourses on the goal of considering patients' preferences.


METHODS



METHODS
Qualitative study using discourse analysis.


METHODS
18 participants (patients, health professionals, and public health experts) from 2 groups of British guideline developers.


METHODS
Template analysis of semi-structured individual interviews was strengthened by active search for deviant cases, team debriefing, and member checking.


RESULTS
All respondents supported the idea of taking account of patients' preferences in guidelines. Divergences with the goal and meaning of considering preferences were structured in 4 discourses: (1) The Governance discourse constructs guideline development as a rational process of synthesizing population data-including evidence on patients' preferences-to maximize public health within the constraints of available resources; (2) the Informed Decision discourse aims at fostering patients' choice by providing tailored information on the risks and benefits of interventions; (3) the Professional Care discourse insists on basing professionals' recommendations on the individual characteristics of patients; (4) The Consumer Advocacy discourse argues for greater political power and influence over guideline development and clinical decision making.


CONCLUSIONS
The identified discourses provide a set of hypothesis on how patient involvement programs are expected to work, which could help clarify the goals pursued by guideline organizations and anchor further evaluation efforts.
Boivin
Antoine
A
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands. antoine.boivin@gmail.com
Green
Judith
J
van der Meulen
Jan
J
Légaré
France
F
Nolte
Ellen
E
D002983:Clinical Competence; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010361:Patients; D010820:Physicians; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000458:organization & administration*