Improving clinical practice guidelines for the 21st century - Attitudinal barriers and not technology are the main challenges

Through the use of three scenarios, this paper presents the challenges for clinical practice guidelines in the 21st century. Such challenges relate to technological developments to improve the efficiency and pace of the devel opment process, to ensure that clinical practice guidelines are kept up to date, and to facilitate implementation of guidelines in the clinical settin g. To improve and ensure the validity of the content of clinical practice g uidelines, we need to address the important problem of publication bias, fo r which researchers, granting agencies, industry, and journal editors share responsibility. This means insisting on registration of trials at their in ception, and incentives backed up by rules for funding and peer review publ ication that would promote behaviors to avoid publication bias. The more di fficult challenges for clinical practice guidelines relate to what are refe rred to as attitudinal factors. To achieve optimal efficiencies in developm ent and maintenance of clinical practice guidelines, we need to promote coo peration among various information resource providers internationally and t o stress partnership over leadership. Finally, there needs to be reconcilia tion of the different stakeholder perspectives of the value and purpose of clinical practice guidelines so that they are used appropriately as aids to decision making and are not abused as tools for controlling clinical pract ice.