A simple, pragmatic strategy for guideline development

Clinical guidelines are systematically developed statements designed to help practitioners and patients make decisions about appropriate health care for specific circumstances.1 Clinicians are being inundated by a tidal wave of guidelines. In Britain alone, regional programmes for audit have recently developed about 2000 guidelines or protocols.2 In addition to numerous clinical guidelines, a number of “guidelines for guidelines” have been produced, ranging from simple3 to complex.4 These reflect the increasing attention being paid to the methodology of guidelines development and the validity of guideline recommendations. While we support the increasingly rigorous approach taken to guideline development, it is important to re-emphasise the central role of guidelines themselves, which is to help clinicians make better decisions.

Clinicians need simple, patient specific, user friendly guidelines. We highlight three key components for such guidelines. The first is the explicit identification of the major decisions, relevant to patients, which have to be made, and the possible consequences of these decisions. Many encounters with patients involve multiple decisions, so the key to developing usable guidelines is to identify …