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(Stroke. 2007;38:2037.)
© 2007 American Heart Association, Inc.

Editorials

Explicit Priority Setting in Clinical Guidelines

The Next Frontier?

Peter Langhorne, PhD, FRCP

From the Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK.

Correspondence to Peter Langhorne, Academic Section of Geriatric Medicine, University of Glasgow, Level 3, Centre Block, Royal Infirmary, Glasgow, UK G31 02ER. E-mail pl11m@clinmed.gla.ac.uk

Key Words: clinical • clinical guidelines • clinical trials • evidence-based practice • outcomes

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 2185–2190.

The last 15 years have seen great improvements in the development of clinical practice guidelines. There are now rigorous methods for conducting systematic reviews of the relevant scientific evidence and for grading the strength of that evidence.¹ However, it is in the next step of the process (generating and implementing recommendations for practice) that difficulties frequently arise. The grade of scientific evidence cannot simply dictate the priorities for clinical practice because of the crucial role of several other considerations. Judgements about the implementation of evidence will include judgements about patient needs, the size and value of treatment effects, and the most appropriate use of resources within a particular healthcare system (and society in general). It is for these reasons that clinical practice guidelines should be developed within the social and cultural context in which they will be applied. In guideline development, this priority setting process has usually reflected the assembled views of the guideline panel and has not been carried out in an explicit manner. Once guidelines come to be implemented in clinical practice, priorities often reflect the intuitive decision-making of clinicians and healthcare managers.

The article by Norrving et al² outlines a novel approach to priority-setting during the development of the Swedish national stroke guidelines. They established a series of committees with a broad representation of many stakeholders including patient representatives. The approach is to be commended because it attempted to make transparent a series of decisions, which are frequently implicit.

Inevitably a . . . [Full Text of this Article]

Related Article:

Beyond Conventional Stroke Guidelines: Setting Priorities

Bo Norrving, Per Wester, Katharina Stibrant Sunnerhagen, Andreas Terént, Anna Sohlberg, Fredrik Berggren, Per-Olov Wester, Kjell Asplund, for the Stroke Guidelines Working Group,, and National Board of Health and Welfare, Stockholm, Sweden
Stroke 2007 38: 2185-2190. [Abstract] [Full Text] [PDF]

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