A framework for practical issues was developed to inform shared decision-making tools and clinical guidelines

J Clin Epidemiol. 2021 Jan:129:104-113. doi: 10.1016/j.jclinepi.2020.10.002. Epub 2020 Oct 10.


Objectives: The objective of the study was to develop and test feasibility of a framework of patient-important practical issues.

Study design and setting: Guidelines and shared decision-making tools help facilitate discussions about patient-important outcomes of care alternatives, but typically ignore practical issues patients consider when implementing care into their daily routines. Using grounded theory, practical issues in the HealthTalk.org registry and in Option Grids were identified and categorized into a framework. We integrated the framework into the MAGIC authoring and publication platform and digitally structured authoring and publication platform and appraised its use in The BMJ Rapid Recommendations.

Results: The framework included the following 15 categories: medication routine, tests and visits, procedure and device, recovery and adaptation, coordination of care, adverse effects, interactions and antidote, physical well-being, emotional well-being, pregnancy and nursing, costs and access, food and drinks, exercise and activities, social life and relationships, work and education, travel and driving. Implementation in 15 BMJ Rapid Recommendations added 283 issues to 35 recommendations. The most frequently used category was procedure and device, and the least frequent was social life and relationship.

Conclusion: Adding practical issues systematically to evidence summaries is feasible and can inform guidelines and tools for shared decision-making. How this inclusion can improve patient-centered care remains to be determined.

Keywords: Clinical practice guidelines; Decision aids; Patient experience; Patient-important outcomes; Shared decision-making tools.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Data Collection
  • Decision Making, Shared*
  • Decision Support Techniques*
  • Humans
  • Patient Generated Health Data
  • Patient Participation / methods*
  • Patient-Centered Care* / methods
  • Patient-Centered Care* / standards
  • Practice Guidelines as Topic
  • Quality Improvement / organization & administration
  • Treatment Outcome*