CITATION: Comment: When no guideline recommendation is the best recommendation
Michael Bretthauer, Mette Kalager
The Lancet Volume 392, Issue 10151, 15–21 September 2018, Pages 898-899

‘The core of clinical practice guidelines is the recommendations. The ideal situation for clinical practice guidelines is when there is an unequivocal body of evidence about the benefits and harms of different treatment options, and related costs and resources.1 Making guidelines and recommending the best treatments in these cases are straightforward. Challenges arise when there is no high-quality evidence. For many specialties in medicine, this is the rule rather than the exception…

‘The current default of making recommendations for each clinical question in every set of guidelines might be counterproductive and hinder new knowledge and thus clinical practice innovation. Fewer recommendations, by abandoning those with the weakest evidence, would be a step in the right direction. If there is little or no evidence, guideline makers should refrain from recommending one or another option. Clinical guideline panels should have the courage to make statements of no recommendation if the evidence base is weak. Such a recommendation could actually be the best guidance and give impetus to important research.’

Best wishes, Neil

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