Introducing JAMA Clinical Guidelines Synopsis

Physicians are busy and often do not have the time to review a single topic in enough depth to successfully aggregate and synthesize current research into a single coherent theme that can guide practice, and they may not have the expertise to critically appraise complex primary research studies and apply the results to determine how best to deliver medical care. The purpose of clinical guidelines is to accomplish these tasks for physicians. However, committees that prepare guidelines often fail to produce a document that most physicians can use. Guideline documents are often hundreds of pages long, making them difficult and time-consuming to read and digest. The deployment of guidelines through electronic medical record decision support tools or applications on handheld electronic devices can be helpful, but these tools cannot assist with the nuanced decision making required for providing care to individual patients.

Another problem with clinical guidelines is that they are not all equal. On the one hand, some guidelines are produced by committees that are unbiased but may lack the content expertise for the clinical problem being assessed. On the other hand, some guidelines are produced by highly specialized committees that have content expertise but are more likely to have conflicts of interest that may lead to biased outcomes. In either situation, the resulting guidelines do not generalize well to primary care populations and the unique circumstances of individual patients.¹

To help address these issues, in this issue of JAMA, we are launching a new series: JAMA Clinical Guidelines Synopsis.² These brief articles concisely summarize guideline recommendations in a format designed for busy physicians. Each article will have an overview of the major recommendations from the guideline, will identify the groups that issued and funded the guideline, and will link to selected associated guidelines and resources. Each article will summarize the clinical problem, review the evidence base for the guideline, note the potential benefits or harms related to instituting the guideline’s recommendations, and suggest future areas of research.

A major feature of JAMA Clinical Guidelines Synopsis articles will be a table that rates the guideline being reviewed, derived from the Institute of Medicine standards for the development of trustworthy guidelines (Table). Adherence with each of these standards will be rated from good to fair to poor. No numerical rating of the guideline will be provided because the 9 standards vary in terms of importance, not all are evidence based, and the rating system is qualitative.

Table.  Guideline Rating^a

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This new article type builds on JAMA’s ongoing effort to bring concise, clearly presented evidence-based medical knowledge to our readers. This effort began with The Rational Clinical Examination series³ in 1992 and the Users' Guides to the Medical Literature⁴ in 1993. Recently, JAMA introduced the JAMA Clinical Evidence Synopsis,⁵ JAMA Diagnostic Test Interpretation,⁶ and JAMA Guide to Statistics and Methods.⁷ The goal of all these new articles is to improve patient care by helping readers interpret medical evidence. We welcome responses from readers regarding this new feature.

Corresponding Author: Edward H. Livingston, MD, JAMA, 330 N Wabash Ave, Chicago, IL 60611 (edward.livingston@jamanetwork.org).

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.