Evidence, Values, Guidelines and Rational Decision-making

Barrett, Bruce

doi:10.1007/s11606-011-1903-6

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…This aspect was given much value in the present project, and long discussions concerned regulatory issues, warnings issued by European or national or regional authorities and on the pros and cons of off-label prescribing. Other discussions concerned value judgements, such as the relevance of treating a specific clinical condition despite the lack of background evidence, and feasibility considerations, often related to local context variables, such as for example medication availability in different psychiatric settings [17]. A challenge of this approach was the relative weight that these aspects should receive in comparison with aspects related to the evidence base.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

Making the use of psychotropic drugs more rational through the development of GRADE recommendations in specialist mental healthcare

Ostuzzi

Bighelli

Carrara

et al. 2013

Int J Ment Health Syst

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IntroductionIn recent years the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology has often been used by international or national health authorities, or scientific societies, for developing evidence-based treatment recommendations. However, the GRADE approach has never been used by practicing physicians who aim at harmonizing their prescribing behaviours paying due attention to the best available evidence. This paper describes the experience of a working group of psychiatrists who adopted the GRADE approach to develop clinical recommendations on the use of psychotropic drugs in specialist mental healthcare.Case descriptionThe project was conducted in the Department of Mental Health of Verona, Italy, a city located in the north of Italy. At the beginning of 2012, psychiatrists with a specific interest in the rational use of psychotropic drugs were identified and appointed as members of a Guideline Development Group (GDG). The first task of the GDG was the identification of controversial areas in the use of psychotropic drugs, the definition of scoping questions, and the identification of outcomes of interest. The GDG was supported by a scientific secretariat, who searched the evidence, identified one or more systematic reviews matching the scoping questions, and drafted GRADE tables.Discussion and evaluationOn the basis of efficacy, acceptability, tolerability and safety data, considering the risk of bias and confidence in estimates, and taking also into consideration preferences, values and practical aspects in favour and against the intervention under scrutiny, a draft recommendation with its strength was formulated and agreed by GDG members. Recommendations were submitted for consideration to all specialists of the Department, discussed in two plenary sessions open to the whole staff, and finally approved at the end of 2012.ConclusionThe present project of guideline development raised several challenging and innovating aspects, including a “bottom-up” approach, as it was motivated by reasons that found agreement among specialists, those who developed the recommendations were those who were supposed to follow them, and values, preferences and feasibility issues were considered paying due attention to local context variables.

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Section: Discussion and Evaluationmentioning

confidence: 99%

Making the use of psychotropic drugs more rational through the development of GRADE recommendations in specialist mental healthcare

Ostuzzi

Bighelli

Carrara

et al. 2013

Int J Ment Health Syst

View full text Add to dashboard Cite

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“…EBM draws heavily from current research findings– especially from large randomized control trials (RCT)[4]. Furthermore, this concept is evolving with the deepening and development of research, being an evolution itself.…”

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confidence: 99%

“…Since judgment and decision making by physicians play an overwhelmingly dominant role in the estimation of futility, evidence-based medicine (EBM) should be included as a general guideline, incorporating individual experience and the best current evidence [3] . EBM draws heavily from current research findings– especially from large randomized control trials (RCT) [4] . Furthermore, this concept is evolving with the deepening and development of research, being an evolution itself.…”

mentioning

confidence: 99%

Medical futility in the era of evidence-based medicine

Jiang

Guo

et al. 2014

J Biomed Res

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“…Patients′ autonomy being incomplete in clinical trials has been argued substantially about in which the legal capacity and psychological capacity is hard to define clearly and doctors′ therapeutic expectations can subjectively decide the competence of patients. The decision-making as “an inherently individualized process” [9] should be alerted because considering vague prediction, the term itself can be defined as a kind of “futility”. Additionally, legislative models for notification of the medical condition and the decision-making isolated from coercive or induced efforts should be established in the future.…”

mentioning

confidence: 99%