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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Rhetoric and argumentation: how clinical practice guidelines think.

Jonathan Fuller¹

¹Faculty of Medicine, University of Toronto, Ontario, Canada. jonathan.fuller@mail.utoronto.ca

Journal of Evaluation in Clinical Practice

|May 23, 2013

Summary

Clinical practice guidelines (CPGs) often fail to adequately justify long-term medication use in older adults. Arguments lack specific evidence for this population, leading to potentially flawed recommendations.

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Area of Science:

Geriatric Medicine
Evidence-Based Practice
Health Sciences Research

Background:

Clinical practice guidelines (CPGs) are crucial for evidence-based medical decisions.
Little attention has been paid to how CPGs justify evidence, especially for long-term medication use in older adults.
This study examines the argumentation in CPGs for commonly prescribed medications in seniors.

Purpose of the Study:

To analyze the logical structure and evidential support of arguments within CPGs recommending pharmacotherapy for older patients.
To identify how CPGs justify treatment recommendations for the elderly population.
To evaluate the quality of reasoning in CPGs concerning medication use in seniors.

Main Methods:

Selection of six disease-specific CPGs recommending five common medication classes for seniors in Ontario, Canada.
Analysis of the stated aims and persuasive techniques used in these CPGs.
Reconstruction and logical analysis of arguments supporting pharmacotherapy recommendations.

Main Results:

CPGs primarily use inductive reasoning, generalizing from randomized controlled trial (RCT) and meta-analysis data.
Two analyzed CPGs attempted to justify pharmacotherapy for older patients using this inductive pattern.
Three CPGs failed to provide specific justifications for pharmacotherapy tailored to the older population.

Conclusions:

The analyzed CPG arguments lack necessary assumptions to generalize medication effectiveness to older populations.
CPGs often exhibit inferential gaps and rely on hasty inductions.
Future CPGs should prioritize robust reasoning, diverse evidence, and appropriately scoped recommendations over simple evidence-based claims.