Guidelines — not always an easy answer
CMAJ 1999;160:984
In response to: T. Vandor; J. Goertzen
Tom Vandor makes the interesting point that we frequently blame the user (the physician) when a clinical practice guideline is not "unanimously" followed, yet there is little research examining the deficiencies of guidelines. As outlined in our editorial, we believe that there are many other factors that affect the adoption of guidelines: physician and patient characteristics, social influences and practice characteristics.
James Goertzen addresses what we believe is an important factor in guideline adoption, the issue of conflicting guideline recommendations from different agencies. He drives this point home by directing our attention to the article on prostate cancer [full text]1 that appears in the same issue as our editorial. It seems almost impossible not to step into the quagmire of conflicting guidelines when examining the recommendations for a common cancer, such as cancer of the prostate. We agree with Goertzen's conclusions: that many clinicians face almost daily difficulties as they discuss with their patients which guidelines to follow.
It is for these reasons that our group is now working on a project, funded by the Medical Research Council of Canada, to determine how family physicians make decisions about cancer screening when the guideline is uncertain or when the guidelines from different agencies conflict.
Fred Tudiver, MD
Director
Center for Evidence Based Practice
State University of New York
Health Science Center at Syracuse
Syracuse, NY
TUDIVERF@mailbox.hscsyr.edu
Carol Herbert, MD
Department of Family Practice
University of British Columbia
Vancouver, BC
Vivek Goel, PhD
Department of Public Health Sciences
University of Toronto
Institute for Clinical Evaluative Sciences
Toronto, Ont.
Remi Guibert, MD
Judith B. Brown, PhD
Alan Katz, MD
Phillip B. Smith, PhD
Sharon Campbell, PhD
Paul G. Ritvo, PhD
J. Ivan Williams, PhD
for the Family Physician Study Group
Sociobehavioral Cancer Research Network
National Cancer Institute of Canada
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Reference
- Gallagher RP, Fleshner N. Prostate cancer: 3. Individual risk factors. CMAJ 1998;159(7):807-13.
