title: The usefulness of NICE guidance in practice: different perspectives of managers, clinicians, and patients.
abstract: OBJECTIVE
  The UK National Institute for Health and Clinical Excellence (NICE) has been widely hailed as an international leader in health technology assessment. The objectives of its guidance are to ensure uniformity in healthcare provision, and promote a systematic and accountable way to allocate resources. However, research relating to the implementation of guidance is limited, and little is known about how it influences decision making at the consultation level or how useful it is to individual patients.
  
  
  METHODS
  In-depth interviews were undertaken with professionals involved in healthcare provision at the community level, and with clinical professionals and patients providing or receiving care for morbid obesity and breast cancer (n = 52).
  
  
  RESULTS
  Although NICE guidance was generally well-regarded, in practice it was of more importance and usefulness to managerial than clinical professionals. Clinicians used a patchy approach to implementation depending on whether recommendations accorded with their personal interpretation of the evidence available, and whether funding was available locally. Many patients had not heard of NICE, and clinical professionals did not alert them to its existence. Even where patients knew about relevant guidance, they were rarely able to use it to assert their right to treatment.
  
  
  CONCLUSIONS
  These findings challenge the perception that NICE guidance results in consistent and accountable decision making, and the limited accessibility and usefulness of guidance to patients suggests more information and support is needed at the point of provision if these objectives are to be achieved.
authors.affiliation: University of Bristol, United Kingdom. a.owen-smith@bris.ac.uk
authors.forename: Amanda
authors.initials: A
authors.lastname: Owen-Smith
authors.forename: Joanna
authors.initials: J
authors.lastname: Coast
authors.forename: Jenny
authors.initials: J
authors.lastname: Donovan
mesh_terms: D026683:Advisory Committees / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006270:Health Facility Administrators / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009765:Obesity / Q000628:therapy; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D013673:Technology Assessment, Biomedical; D006113:United Kingdom