Clinical Practice Guidelines We Can Trust

Clinicians can no longer stay abreast of the rapidly expanding knowledge bases related to health. The number of randomized controlled trials published in MEDLINE (a medical literature database) grew from 5,000 per year in 1978–1985 to 25,000 per year in 1994–2001. Furthermore, contentions that much of the literature may be biased and not applicable to important subsets of target populations have caused its quality to be suspect. Overall, clinicians increasingly are barraged with a vast volume of evidence of uncertain value. Hence, critically appraised and synthesized scientific evidence has become fundamental to clinical practice. At the same time, and particularly under conditions of uncertainty regarding optimal decisions, clinician experiential knowledge and skill (the “art of medicine”) and patient values and preferences remain essential contributors to quality healthcare practice, in a complex interplay with science. Clinical practice guidelines (CPGs) embody and support the interrelationships among these critical contributors to clinical decision making. Rather than dictating a one-size-fits-all approach to patient care, CPGs are able to enhance clinician and patient decision making by clearly describing and appraising the scientific evidence and reasoning (the likely benefits and harms) behind clinical recommendations, making them relevant to the individual patient encounter. Although it remains important for CPGs to be evaluated fully for their effectiveness in improving health, when rigorously developed, they have the power to translate the complexity of scientific research findings into recommendations for clinical practice and potentially enhance healthcare quality and outcomes. However, the current state of CPG development has yet to meet this potential.