Digitalising Clinical Guidelines: The Challenge of Patient's Preferences

Area of Science:

• Health Informatics
• Clinical Decision Support
• Personalized Medicine

Background:

• Digitalisation of clinical guidelines aims to improve healthcare delivery.
• Personalised patient care requires consideration of individual preferences.
• Current guidelines may embed non-neutral preferences within disease definitions.

Purpose of the Study:

• To assess the compatibility of digitalised clinical guidelines with personalised patient care.
• To identify embedded preferences in disease definitions within clinical guidelines.
• To explore the implications of these preferences for patient-centred care.

Main Methods:

• Case study focusing on bone health and osteoporosis definitions.
• Analysis of diagnostic and intervention thresholds in UK clinical guidelines.
• Examination of the influence of expert consensus and cost-effectiveness on guideline development.

Main Results:

• The definition of osteoporosis relies on a 1992 expert committee's preference for a bone mineral density threshold.
• UK clinical guidelines adopt this diagnostic threshold and incorporate preference-sensitive intervention thresholds.
• These embedded preferences preempt patient choices, hindering personalised care.

Conclusions:

• Digitalised guidelines face conceptual challenges in accommodating personalised care.
• Embedded preferences in disease definitions must be addressed for computable guidelines to support individualised patient care.
• Future digitalisation efforts should focus on both technical and conceptual aspects to enable true personalised medicine.