Including practical issues and patient perspectives in Rapid Recommendations

Treatment burden is an often ignored but crucial element in guidelines and clinical decision making.1 We would like to point out some recent advances.

Treatment burden could be appraised in a broader framework of “practical issues” related to how a treatment or test will affect a patient’s daily life. These include issues related to drug routine, the need for subsequent tests, coordination of care, and the implications of decisions on social activities, work, and travel. Clinicians need to raise these topics with patients to find out what is best for each person, ideally through shared decision making.

To do so, guidelines and evidence summaries should systematically include practical issues. Our team in the non-profit MAGIC research and innovation programme (http://magicproject.org) has developed a publication platform (http://magicapp.org) that enables organisations to easily add practical issues to their evidence summaries, recommendations, and decision aids.2 We are preparing a manuscript on how we developed the new framework and tools.

As our work with The BMJ on Rapid Recommendations shows,3 guideline panels can explicitly take practical issues into account and provide them to clinicians and patients to support their decisions. The experience has been educational, with examples of direct effects on the recommendations. The panels also use new sources of evidence, such as www.healthtalk.org. We have partnered with patients to systematically include their perspectives. This information is incorporated in our SHARE-IT decision aids,4 accessible in MAGICapp through each Rapid Recommendation.

This is an emerging field that will require more research. Another question is how to include practical issues throughout the evidence ecosystem, not only in guidelines, but also in systematic reviews.