Incorporación de la perspectiva de los pacientes en las guías de práctica clínica: una aproximación metodológica

Abstract

Background_x000D_ Clinical practice guidelines (GCP) are knowledge transfer tools that can facilitate informed decisionmaking,_x000D_ improve healthcare, reduce unwanted variability, and optimize the use of resources. Incorporating_x000D_ the patients’ perspective in CPGs increases their quality, legitimacy and transparency, facilitates the_x000D_ implementation of their recommendations and favours patient empowerment. However, there is currently_x000D_ no well-established methodology for incorporating the patients’ perspective in CPGs._x000D_ Objectives_x000D_ The general objectives of this thesis are: 1) to identify and describe the methods used to incorporate the_x000D_ patients’ perspective in the development of CPGs and 2) to design and evaluate new methods that facilitate_x000D_ the incorporation of the patients’ perspective in CPGs._x000D_ Methodology_x000D_ This thesis work is presented as a compendium of three papers published in peer-reviewed biomedical_x000D_ journals. In the first study, we developed a systematic review of CPGs methodological handbooks. The main_x000D_ objective was to identify the proposed methods for incorporating patients and their perspectives in the_x000D_ development of CPGs._x000D_ In the second study, we conducted a systematic evaluation of colorectal cancer CPGs. The main objective was_x000D_ to describe the methods used to incorporate the patients’ perspective in their development and specifically,_x000D_ in the formulation of recommendations._x000D_ In the third study we developed a bibliographic search strategy to identify studies on patients’ views and_x000D_ preferences in PubMed (search engine for MEDLINE database), evaluated its performance and implemented_x000D_ it in different knowledge synthesis projects._x000D_ Results_x000D_ In the first study, we included methodological handbooks from 56 GPC development organizations. Most_x000D_ organizations recommended including patients in the GPC development process, especially in formulating_x000D_ clinical questions and recommendations. Less than half of the organizations offered information on how_x000D_ to do so. Most organizations also recommended other strategies for obtaining and considering patients’_x000D_ perspectives._x000D_ In the second study, we included 28 colorectal cancer GPCs. Less than half of GPCs included patients or_x000D_ scientific evidence related to the patient’s perspective, and those that did it, provided little detail on the_x000D_ role of participating patients or the methodology used to incorporate evidence. Patients’ perspectives were_x000D_ considered in a minority of potentially preference-sensitive recommendations. The incorporation of patients_x000D_ in the CPG development process was associated with a greater consideration of the patients’ perspective in_x000D_ recommendations._x000D_ In the third study, we developed a bibliographic search strategy that showed a relative recall of 85.8%. Its_x000D_ implementation in practice showed a low precision (from 2 to 5%), with a number of references needed to_x000D_ read between 20 and 50._x000D_ Conclusions_x000D_ Methodological handbooks for the development of CPG do not provide information in sufficient detail_x000D_ on how to incorporate the patients’ perspective in CPGs. The incorporation of the patients’ perspective in_x000D_ colorectal cancer CPGs is not adequate and only a minority of patient preference-sensitive recommendations_x000D_ actually takes them into account. The search strategy developed is useful for conducting systematic reviews_x000D_ on patients’ perspective and facilitating the incorporation of this aspect in CPGs.

Date of Award	11 Dec 2020
Original language	Spanish
Supervisor	Pablo Alonso Coello (Director) & Laura Martinez Garcia (Director)