Do a Clinical Practice Guideline Facilitate Shared Decision-Making? Development of a French Assessment Tool Using the Delphi Consensus Method

Abstract

Background: Evidence-based medicine (EBM) is a prime component of medical practice. EBM often translate into clinical practice guidelines (CPG) widely used by healthcare providers. However, CPGs are often focused on a specific pathology, and they rarely make a room for shared decision-making (SDM) another key dimension, centered on the information exchange between the physician and the patient, the deliberation/discussion, and the decision made based on a common agreement. An assessment tool is therefore needed to determine whether the structure of CPGs allows or not the integration of SDM.

Objectives: To develop an assessment tool in French that could quantify the degree to which CPG facilitate SDM by translating and adapting the elements developed in international consensus studies.

Method: A Delphi consensus method including seven experts selected from the leading scientific community on the topic. Consensus was considered to have been reached when the approval rate reached 70%.

Results: A consensus for the adaptation, relevance, and adjustment of 19 strategies was reached after three rounds. Based on these strategies, 17 criteria were developed. They 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,” and recommendation-specific strategies such as giving to the patient a copy of his/her personalized treatment plan, recommending which patient decision aid could be used and when, or encouraging the patient to exchange with close relatives and friends for the discussion.

Conclusion: We developed a 17-item tool to assess whether or not a CPG facilitates sustainable development. This tool will have to be tested to ensure that it is easy to use, relevant and reproducible, and thus meets the expected quality criteria. Such a tool would enable researchers and patients alike to assess CPGs using a common benchmark, would support national and international benchmarking processes, and provide a starting point for future improvement. Translations into other languages could broaden the scope of use.