Framework for enhancing clinical practice guidelines through continuous patient engagement.
Patient engagement in clinical practice guideline (CPG) development is recommended by multiple institutions and instruments measuring guideline quality. Approaches to engaging patients, however, vary between oversight organizations, quality tools and guideline developers.



We propose a ten-step framework outlining steps and options for patient engagement in guideline development with the goal of highlighting steps for patient engagement and methods by which this can be achieved.



This framework provides a model for continuous patient engagement in CPGs by outlining ten steps of guideline development occurring at the levels of the developer/committee and the individual guideline project. At the developer level, patients can assist in topic nomination (step 1), topic prioritization (step 2) and guideline development group selection (step 3). Within specific guideline projects, patients' opinions may be incorporated when framing the question (step 4), creating an analytic framework and research plan (step 5), conducting the systematic review and conclusion formation (step 6), development of recommendations (step 7) and dissemination and implementation (step 8). At the end of process, patients can again be engaged at the developer level by helping determine when guidelines need updating (step 9) and evaluating the developer's approach to patient engagement (step 10).



Patient engagement at each CPG development step has different purposes, mechanisms, advantages and disadvantages, and implications for resource utilization. This framework can serve as a resource for guideline developers desiring to increase patient engagement and reference for researchers investigating engagement methodology at different steps of the CPG lifecycle.
Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.|Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Melissa J
MJ
Armstrong
Pharmaceutical Health Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Juan-David
JD
Rueda
Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
Gary S
GS
Gronseth
Pharmaceutical Health Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA.
C Daniel
CD
Mullins
D002985:Clinical Protocols / Q000592:standards*; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration*
decision-making; guideline adherence; guidelines as topic; patient participation; patient-centred care