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Thanks Xiaomei. So glad you agree. However, in my opinion it’s not about asking working group members to discuss or think about patient’s values but rather write the guideline with the specific intention of providing information in a way that allows people to make a shared decision. A guideline should in most cases, as much as possible, stay away from recommendations but provide a synopsis of the best available (and all the limitations etc) and tools that allow clinicians to individualize risk assessments and to describe the potential benefits and harms (all with numbers). Sadly guidelines typically fail miserably in this area. James > On Jun 14, 2016, at 8:21 AM, Yao, Xiaomei <[log in to unmask]> wrote: > > Hi James, > > I totally agree with you that we should take patients’ value and preference into account when we conduct clinical practice guidelines. This is what GRADE tool always emphasizes http://gdt.guidelinedevelopment.org. In our organization (Cancer Care Ontario), when we make recommendations from literature evidence, we ask the working group members to consider several questions and one of them is, “Is there important uncertainty about how much patients value the outcomes?” The working group includes clinicians, a methodologist, and patient representative(s) if possible. https://www.cancercare.on.ca/toolbox/qualityguidelines/diseasesite/ > > Thanks, > Xiaomei > > -----Original Message----- > From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of McCormack, James > Sent: June-14-16 10:03 AM > To: [log in to unmask] > Subject: Re: EBP stifles innovation and creativity > > I think Oliver is correct - guidelines definitely inhibit clinicians BUT EBP does not equal guidelines - in fact only ~ 10% of guideline recommendations are based on RCTs and almost none of them include the tools or evidence synopsis to allow clinicians to incorporate patient values and preferences. > > My recent guideline video might provide some levity/toe-tapping to the discussion - https://youtu.be/DHDnqQ_mCBA > > James > >> On Jun 14, 2016, at 12:49 AM, Oliver Fisher <[log in to unmask]> wrote: >> >> I cannot speak to OT, but I personally do believe that there is a certain amount of “inhibition" of innovation by having to completely adhere to EBP guidelines and how quality data is generated to “prove that something works”. I think it’s also fair to say, that because of some of the “EBP success stories” or moreover “debunking of old (and new) myths” particularly institutional review boards and alike have become more rigorous (which is good) but sometimes less enthusiastic towards certain study proposals that could be highly innovative when they charter in to unknown territory. I think it’s important to note, that some of the greatest success stories of modern medicine (bone marrow and organ transplants, immunosuppression etc.) were achieved at a time, where “clinical trials” really meant the latter word. I believe overall the broader effect EBP/EBM has had has been great, but it has made the process very “bureaucratic” and sometimes I wonder if more time/money is being spent on trying to set up trials than actually conducting them…and that this may deter many people from actually getting involved and trying to push the envelope. >> >> Sorry - not so helpful for you to speak against the motion, but it may >> trigger some thoughts against what I’ve said :-) >> >> Oliver >> >>> On 14.06.2016, at 15:02, Clare Taylor <[log in to unmask]> wrote: >>> >>> Dear all >>> >>> I am soon to be taking part in a debate, the motion being that EBP >>> stifles creativity and innovation in OT practice - I am speaking >>> against the motion, and I would be very grateful for any thoughts >>> from the group in this topic >>> >>> Thanks in advance >>> >>> Clare >>> >>> Dr M Clare Taylor >>> Professional Lead for Occupational Therapy Bournemouth University >>> [log in to unmask] >>> 07703 888 099 >>> BU is a Disability Two Ticks Employer and has signed up to the Mindful Employer charter. Information about the accessibility of University buildings can be found on the BU DisabledGo webpages This email is intended only for the person to whom it is addressed and may contain confidential information. If you have received this email in error, please notify the sender and delete this email, which must not be copied, distributed or disclosed to any other person. Any views or opinions presented are solely those of the author and do not necessarily represent those of Bournemouth University or its subsidiary companies. Nor can any contract be formed on behalf of the University or its subsidiary companies via email. >