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.