• Trudy van der Weijden, Arwen H Pieterse, Marije S Koelewijn-van Loon, Loes Knaapen, France Légaré, Antoine Boivin, Jako S Burgers, Anne M Stiggelbout, Marjan Faber, and Glyn Elwyn.
• Department of General Practice, CAPHRI School of Public Health and Primary Care, Maastricht University, , Maastricht, The Netherlands.
• BMJ Qual Saf. 2013 Oct 1;22(10):855-63.

BackgroundTo explore how clinical practice guidelines can be adapted to facilitate shared decision making.MethodsThis was a qualitative key-informant study with group discussions and semi-structured interviews. First, 75 experts in guideline development or shared decision making participated in group discussions at two international conferences. Next, health professionals known as experts in depression or breast cancer, experts on clinical practice guidelines and/or shared decision making, and patient representatives were interviewed (N=20). Using illustrative treatment decisions on depression or breast cancer, we asked the interviewees to indicate as specifically as they could how guidelines could be used to facilitate shared decision making.ResultsInterviewees suggested some generic strategies, namely to include a separate chapter on the importance of shared decision making, to use language that encourages patient involvement, and to develop patient versions of guidelines. Recommendation-specific strategies, related to specific decision points in the guideline, were also suggested: These include structuring the presentation of healthcare options to increase professionals' option awareness; structuring the deliberation process between professionals and patients; and providing relevant patient support tools embedded at important decision points in the guideline.ConclusionsThis study resulted in an overview of strategies to adapt clinical practice guidelines to facilitate shared decision making. Some strategies seemed more contentious than others. Future research should assess the feasibility and impact of these strategies to make clinical practice guidelines more conducive to facilitate shared decision making.

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