Faster and trustworthy guidelines for shared decision making - Thomas Agoritsas - 21022019

The volume and complexity of new evidence published every day require guidance for clinicians. Yet, at the same time the majority of important decisions in health care are not clear cut and require shared decision making. More than two thirds of recommendations include in widely used evidence summaries are weak recommendations. And the proportion of preference-sensitive decisions is likely even higher, given the numerous comorbidities that patients present in real clinical practice.

Therefore guidance to clinicians and tools for shared decision making should go hand in hand. To engage into collaborative deliberation, both patients and clinicians need to have an easy access to current best evidence in ways that support meaningful conversations. However, traditional decision aids have been hard to produce, onerous to update, and are not being used widely at the point of care. Similarly, and despite major progress on synthesis and appraisal, the production and dissemination of guidelines has largely been tailored to meet the educational needs of clinicians, and are not suited for shared decision making.

In this presentation, we will explore new developments in the semi-automated production of decision aids from digitally-structured evidence summaries in guidelines, using our web-based authoring and publication platform: the MAGICapp (www.magicapp.org). We will discuss opportunities as well as challenges with this generic approach, including limitations with the available evidence, patients’ need to discuss practical issues, and questions of presentation formats.

We will illustrate how guidelines and decision aids can be produced together in our recent BMJ Rapid Recommendations (http://www.bmj.com/rapid-recommendations), and discuss how efforts to enhance a trustworthy digital Evidence Ecosystem may help provide a stream of patient centered evidence conveyed to patients and clinicians for a wide array of clinical decision.

Thomas Agoritsas, MD, PhD, is a hospital-based general internist and health research methodologist, at the University Hospitals of Geneva, Switzerland – as well as assistant professor at McMaster University, Canada.

His research focuses on real-life implementation of Evidence-Based Medicine. This involves methods for moving from evidence to recommendation, strategies to enhance clinicians’ evidence retrieval at the point of care, and using evidence for shared-decision making.

He is board member of MAGIC Foundation (www.magicproject.org), a non-for profit organization that provides a authoring and publication software (www.MAGICapp.org) for evidence summaries, guidelines and decision aids. In this context, he is leading the SHARE-IT project, which aims at creating a new generation of Decision Aids from evidence summaries and practice guidelines. Within MAGIC, he is also co-founded the BMJ Rapid Recommendations (http://www.bmj.com/rapid-recommendations), which accelerate evidence into practice to answer the questions that matter quickly and transparently through trustworthy recommendations.