Criteria to prioritize clinical practice guideline recommendations for patient decision aid development: results from a modified Delphi consensus study

Background and Objectives: 

Linking patient decision aids (PtDAs) to clinical practice guidelines (CPGs) can improve the integration of patient preferences into health care decisions. However, due to the extensive number of recommendations in many CPGs and the limited resources available to CPG development groups, developing a PtDA for each recommendation may be impractical. This study aimed to develop and rank criteria to prioritize CPG recommendations for which the development of a PtDA is relevant.

Methods: 

A modified three-round Delphi study was conducted between July and December 2024, following the Research and Development (RAND)/University of California at Los Angeles (UCLA) Appropriateness Method (RAM). Potential criteria were derived from selected evidence sources. Criteria reaching at least 75% agreement on the importance threshold in round 1 were retained for ranking in rounds two and three and finalized into a list. Each round comprised a pilot-tested online survey, and responses were analyzed descriptively. Following each survey round, experts discussed the respective results in a recorded videoconference, which was transcribed and analyzed through qualitative content analysis.

Results: 

Twenty-five experts in shared decision-making (SDM) and CPG development from eight countries participated. From an initial set of twelve proposed criteria, two were excluded after round 1 due to insufficient agreement, and two others were merged with related criteria. The remaining eight were ranked during rounds two and three, resulting in a consensus-based final list of criteria. Multiple options with different benefit-harm profiles was ranked as most important, with a mean rank of 1.6 (SD 1.4) on a scale from 1 (most important) to 8 (least important). Decision with impact and potential discrepancy in preferences were ranked second and third, with mean ranks of 2.8 (1.8) and 4.0 (2.1), respectively. The others, in order of importance, were treatment burden (4.1; (1.2)), uncertainty of evidence (5.3; (2.1)), life values (5.8; (1.7)), adherence (6.2; (1.3), and financial aspects (6.3; (1.6)).

Conclusion: 

This study provides a consensus-based list of criteria to assist CPG developers in prioritizing recommendations for PtDA development, emphasizing decisions where PtDAs are most needed. Future research will focus on refining these criteria into a practical tool for CPG developers.