Clinical relevance rather than evidence existence: The SAEM GRACE pragmatism

Abstract

Just because you don't see something, doesn't mean it isn't there. The stars are always there.-R.C. LewisThe Institute of Medicine's "Clinical Practice Guidelines We Can Trust" defined clinical practice guidelines as "statements that include recommendations that are intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." 1 Traditionally, the path to constructing these guidelines has followed the trail of evidence. However, a shift has emerged, challenging the notion that crafting PICO (patient, intervention, comparison, outcome) questions in areas with existing evidence should be the sole compass for guideline development. Specifically, the paradigm shift is that contemporary guidelines should address dilemmas faced in practice rather than only topics where abundant evidence exists.