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Diversity in clinical guidelines: the role of repertoires of evaluation

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  • Moreira, Tiago

Abstract

Clinical practice guidelines are one of the main tools by which clinicians, policy makers and patients hope to make health care less variable, more reliable and efficient, but there is little understanding of the processes by which clinical guidance is put together by guideline groups. This paper describes the social organisation of knowledge within clinical practice guideline development processes by drawing on the sociology of situated judgement. Two guideline development processes were observed, and the development group meetings (N=21) recorded and analysed qualitatively. Data analysis suggested that clinical guidance comes to existence through the combination of repertoires of evaluation, organised around four different epistemic criteria: robustness, usability, acceptability and adequacy. This research provides a detailed and layered understanding of the knowledge dynamics involved in developing recommendations for appropriate health care for specific clinical circumstance.

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  • Moreira, Tiago, 2005. "Diversity in clinical guidelines: the role of repertoires of evaluation," Social Science & Medicine, Elsevier, vol. 60(9), pages 1975-1985, May.
    • Handle: RePEc:eee:socmed:v:60:y:2005:i:9:p:1975-1985
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    1. Wood, Martin & Ferlie, Ewan & Fitzgerald, Louise, 1998. "Achieving clinical behaviour change: a case of becoming indeterminate," Social Science & Medicine, Elsevier, vol. 47(11), pages 1729-1738, December.
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    3. Alexander Schniedermann, 2021. "A comparison of systematic reviews and guideline-based systematic reviews in medical studies," Scientometrics, Springer;Akadémiai Kiadó, vol. 126(12), pages 9829-9846, December.
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    5. Lösch, Lea & Willems, Willemine & Bongers, Marloes & Timen, Aura & Zuiderent-Jerak, Teun, 2023. "Kaleidoscopic integration: Advancing the integration of incommensurable knowledge in healthcare guidelines," Social Science & Medicine, Elsevier, vol. 339(C).
    6. Wieringa, Sietse & Engebretsen, Eivind & Heggen, Kristin & Greenhalgh, Trish, 2021. "Clinical guidelines and the pursuit of reducing epistemic uncertainty. An ethnographic study of guideline development panels in three countries," Social Science & Medicine, Elsevier, vol. 272(C).
    7. Moreira, Tiago, 2011. "Health care rationing in an age of uncertainty: A conceptual model," Social Science & Medicine, Elsevier, vol. 72(8), pages 1333-1341, April.
    8. France Légaré & Antoine Boivin & Trudy van der Weijden & Christine Pakenham & Jako Burgers & Jean Légaré & Sylvie St-Jacques & Susie Gagnon, 2011. "Patient and Public Involvement in Clinical Practice Guidelines," Medical Decision Making, , vol. 31(6), pages 45-74, November.
    9. Lehoux, Pascale & Daudelin, Genevieve & Demers-Payette, Olivier & Boivin, Antoine, 2009. "Fostering deliberations about health innovation: What do we want to know from publics?," Social Science & Medicine, Elsevier, vol. 68(11), pages 2002-2009, June.
    10. Wilson, Nicky & Pope, Catherine & Roberts, Lisa & Crouch, Robert, 2014. "Governing healthcare: Finding meaning in a clinical practice guideline for the management of non-specific low back pain," Social Science & Medicine, Elsevier, vol. 102(C), pages 138-145.
    11. Clinch, Megan & Benson, John, 2013. "Making information ‘relevant’: General Practitioner judgments and the production of patient involvement," Social Science & Medicine, Elsevier, vol. 96(C), pages 104-111.
    12. Allen, Davina, 2009. "From boundary concept to boundary object: The practice and politics of care pathway development," Social Science & Medicine, Elsevier, vol. 69(3), pages 354-361, August.
    13. Broom, Alex & Adams, Jon & Tovey, Philip, 2009. "Evidence-based healthcare in practice: A study of clinician resistance, professional de-skilling, and inter-specialty differentiation in oncology," Social Science & Medicine, Elsevier, vol. 68(1), pages 192-200, January.
    14. Faulkner, Alex & Kent, Julie & Geesink, Ingrid & FitzPatrick, David, 2006. "Purity and the dangers of regenerative medicine: Regulatory innovation of human tissue-engineered technology," Social Science & Medicine, Elsevier, vol. 63(9), pages 2277-2288, November.
    15. Taipale, Jaakko & Hautamäki, Lotta, 2021. "Clinical practice guidelines in courts’ representation of medical evidence and testimony," Social Science & Medicine, Elsevier, vol. 275(C).
    16. Bourret, Pascale & Keating, Peter & Cambrosio, Alberto, 2011. "Regulating diagnosis in post-genomic medicine: Re-aligning clinical judgment?," Social Science & Medicine, Elsevier, vol. 73(6), pages 816-824, September.

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