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282 Does a clinical practice guideline facilitate shared decision making? Development of a french assessment tool using the delphi consensus method
  1. Yves-Marie Vincent1,
  2. Alienor Daron1,
  3. Pauline Panek1,
  4. Anik Giguere2,
  5. Jean-Philippe Joseph1,
  6. François Blot3,
  7. Nora Moumjid4,5
  1. 1Department of General Practice, Université de Bordeaux, Bordeaux, France
  2. 2Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Canada
  3. 3Université Paris-Saclay, Gustave-Roussy, Villejuif, France
  4. 4Léon Bérard center, GRESAC (Axe health economy, GATE, UMR 5824 CNRS), Lyon, France
  5. 5Léon Bérard center, University Claude Bernard Lyon 1, Lyon, France


Introduction Modern medical practice relies on two main concepts: evidence-based medicine (EBM), for its scientific approach, and shared decision making (SDM), that optimizes health care through the patient doctor relationship. Where clinical practice guidelines (CPG) have made their way into daily practice as an operational form of EBM, shared decision making is struggling to settle in. lt appears that CPGs do not encourage shared decision-making but no tool is currently able to verify it.

Method Using the Delphi Method, we translated and converted strategies put forward in How can CPGs be adapted to facilitate SOM into a French appraisal tool that could quantify SDM in CPGs.

Results Three rounds of online questionnaires enabled 7 international SDM experts from the FREeDOM collaboration to reach consensus for the translation, pertinence and adjustment of these 19 strategies into assessment criteria. The 17 criteria produced include general strategies such as adding a specific chapter on SDM, using wording that makes patient involvement explicit, presenting outcomes, benefits and harms of all options including ’doing nothing’; as well as recommendation-specific strategies such as giving the patient a copy of his individualized treatment plan, recommending which patient decision aid should be used and when, or encouraging the patient to engage a proxy for the deliberation.

Conclusion By assessing whether a CPG facilitates SDM, this appraisal tool could help bridge the gap between EBM and patient-centered medicine. lt will need to be tested for ease of use, pertinence and reproducibility.

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