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I would add that the use of Balance Sheets, can be very helpful tor the process you are going through. You can incorporate the value items into the balance sheet, and see them with some of the clinical and/or fiscal material. See Braddick, M; Stuart, M; Hrachovec, J. The Use of Balance in Developing Clinical Practice Guidelines. JABFP, Jan-Feb. 1999, Vol. 12, No. 1 p. 48-54.
Best Regards,
Dan Sontheimer, MD
Spartanburg, SC USA
-----Original Message-----
From: Gene Feder [SMTP:[log in to unmask]]
Sent: Monday, July 17, 2000 9:53 AM
To: [log in to unmask]
Cc: [log in to unmask]
Subject: Re: How to make or write a relative value in cpg
Dear Sanguansak
Date sent: Mon, 17 Jul 2000 08:56:28 -0700 (GMT)
Subject: How to make or write a relative value in cpg
From: sanguansak thanaviratananich <[log in to unmask]>
To:
Send reply to: sanguansak thanaviratananich <[log in to unmask]>
>
> I and our colleagues are writing a national guideline for allergic
> rhinitis. We have some questions to ask
> 1. How can we make a relative value judgement of different options in
> the CPG acccoding to the viewpoints of doctors, patients, society in a
> sensible way?.
Well, value judgements can only be reported if they are elicited, so you need some primary research on treatment preferences for allergic rhinitis. Worth searching for briefly, but I doubt there is much out there (the only field where I know it has been done is oncology). Mind you, when someone makes a statement like this in this forum, there is usually a flood of messages showing how ignorant they are...
> 2.Where can I find a useful document as a guide for making a value
> judgement?
There is no guide for allocating treatment preferences independent of condition and relevant stakeholders. Decision analysis is a method of deriving individual preferences for treatment. David Eddy and Jack Dowie have written extensively on this, but I don't think their work solves your problem.
One ad hoc approach for a guidelines project is to make sure that you have different docs (ie. specialists, generalists) and patients on your group in an attempt to balance different clinical and societal perspectives. It is possible to make some of these judgements explicit: eg. "nasal steroid are more clinically effective than anti- histamines, but the panel thought that the latter are more convenient to use". Alternatively you could list the pros and cons of different treatment options and let the reader and their patient decide!
Good luck.
Gene Feder
Department of General Practice and Primary Care
St Bartholomew's and Royal London Hospital Medical and Dental School
Queen Mary and Westfield College
Mile End Road
London E1 4NS
020 7882 7957 (tel)
020 7882 7911 (fax)
01426 632 748 (pager)