Clinicians and patients may develop care plans from clinical practice guidelines. To be trustworthy, guidelines should result from a rigorous, inclusive, and transparent process, informed by the best available research evidence and safeguarded against biases and conflicts of interest.1 Their guidance should be clear, specific, graded by likelihood of benefit and harm, and actionable. Guidelines are increasingly recommending shared decision-making (SDM),2 an approach in which patients and clinicians work together to develop a shared appreciation of the patient’s situation and decide how to respond well to it.3 The increasing recommendation of SDM in guidelines is problematic insofar as the extent to which the guideline recommendations are reliable, useful, usable, and desirable remains unclear.