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Treatment burden should be included in clinical practice guidelines

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4065 (Published 12 October 2018) Cite this as: BMJ 2018;363:k4065
  1. Claudia C Dobler, consultant pulmonologist1 2 3,
  2. Nathan Harb, medical student3,
  3. Catherine A Maguire, patient involvement and engagement2,
  4. Carol L Armour, professor of pharmacology24,
  5. Courtney Coleman, patient involvement and engagement5,
  6. M Hassan Murad, professor of medicine1
  1. 1Evidence Based Practice Center, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
  2. 2Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
  3. 3South Western Sydney Clinical School, University of New South Wales, NSW, Sydney, Australia
  4. 4Central Sydney Area Health Service, Sydney, NSW, Australia
  5. 5European Lung Foundation, Sheffield, UK
  1. Correspondence to: C C Dobler dobler.claudia{at}mayo.edu

Claudia Dobler and colleagues argue that clear information on treatment burden in guidelines could improve decision making

Implementation of medical treatment regimens demands a lot of time and effort and can result in substantial burden for patients with chronic conditions. Guideline recommendations, however, are traditionally made from a perspective that places the highest value on achieving certain clinical outcomes (such as reducing shortness of breath or increasing survival). More recent guidelines may consider patients’ values and the acceptability and feasibility of the recommended action, but the treatment burden is not made explicit. This makes it hard for patients to make informed decisions about treatments in line with their values and capacity.

What is burden of treatment?

Although the burden of disease is a well known epidemiological concept, the burden of treatment is a less known and fairly recently coined term. Burden of treatment is the workload of healthcare and its effect on patient functioning and wellbeing.1 The cumulative treatment workload for patients with chronic conditions when enacting all recommendations in disease specific guidelines can be overwhelming.2

To cope with the demands of complex self care, patients rely on a range of personal, social, and healthcare resources.3 Disease treatment can occupy a large part of patients’ day and limit the amount of time they can spend on other activities such as work, studying, leisure, childcare, and being with friends and family. A study found that in order to comply with all disease specific guidelines patients with three chronic conditions (any combination of chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, osteoarthritis, hypertension, and depression) would take from six to 13 different drugs a day, visit a health professional 1.2 to 5.9 times a month, and spend a mean (SD) of 49.6 (27.3) to 71.0 (34.5) hours each month in health related activities. …

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