title: How can clinical practice guidelines be adapted to facilitate shared decision making? A qualitative key-informant study.
abstract: 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.
authors.affiliation: Department of General Practice, CAPHRI School of Public Health and Primary Care, Maastricht University, , Maastricht, The Netherlands.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.forename: Marije S
authors.initials: MS
authors.lastname: Koelewijn-van Loon
authors.forename: Loes
authors.initials: L
authors.lastname: Knaapen
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Antoine
authors.initials: A
authors.lastname: Boivin
authors.forename: Jako S
authors.initials: JS
authors.lastname: Burgers
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
authors.forename: Marjan
authors.initials: M
authors.lastname: Faber
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
mesh_terms: D003657:Decision Making; D019049:Developed Countries; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D036301:Qualitative Research
keywords: Clinical practice guidelines; Quality improvement; Shared decision making