CLINICAL GUIDELINES - WHERE NEXT

In a growing number of countries, guidelines are playing an increasing ly important role in assuring the quality of care, Their validity depe nds on a systematic development process and explicit links between rec ommendations and underlying evidence, Their role in aiding clinical de cision making depends on their developers identifying the key decision s and their consequences; gathering the relevant evidence on the risks and costs of alternative decisions; and presenting the appropriate ev idence to make each key decision in a simple and accessible format, po ssibly electronic, Decision analysis is a potentially powerful tool fo r clarifying clinical decisions and involving patients directly in the process but its routine use in guidelines is complex and has yet to b e fully evaluated, Duplication of guidelines can be avoided by apprais ing and adapting existing guidelines in local contexts. There is very little evidence available about the impact of guidelines on the doctor -patient relationship. They might have a potentially deleterious effec t, but the combination of explicit guidelines eliciting patient prefer ences and information technology might redress the balance by increasi ng the role of patients themselves. (C) 1997 Elsevier Science Ltd.