• Result in clinicians changing their attitudes about treatment choices, which will lead to improve outcomes by providing a better quality of patient care.
• Include explicit statements that explain the process of creating the recommendations and the systematic search an gauging of the evidence.
• The development of clinical proactive guidelines that summarize the evidence and provide recommendations is one step in fostering evidence-based practice.
• Outcomes for different interventions and patient preferences for different interventions are important for the use of evidence-based guidelines.

Five Steps In Evidence-Based Guideline Development (Shekelle et al., 1999)

1.  Identify the subject area and the need for the guideline.
2.  Create a development group and identify specific roles of the members of the group.
3.  Determine rules for identifying and assessing evidence before searching for evidence.
4. Specify a method for translating evidence from different types of studies into a recommendation needs, which need to consider benefits of the intervention, limitations, the population, costs, and factors related to the health care system.
5. Specify a method of review and process to update the guideline.

1. Evidence-Based Clinical Guidelines
2. Expert-Based Guidelines (Consensus-Based Guidelines)
3. Outcome-Based Guidelines
4. Preference-Based Guidelines

• Systematic reviews of evidence can be a benefit to busy clinicians as evidence can be combined and summarized in one source.
• Guidelines make a recommendation based on all the issues that may influence a clinical decision in addition to the identification of the available evidence.
• Recommendations of practice guidelines typically are enhanced by the inclusion of systematic review of the current literature. On the other hand, systematic reviews may be included in clinical practice guidelines, but are not required.

A valid guideline should:

• Consider all of the important treatment choices and consequences.
• Provide publication dates for evidence considered and for the creation of the final recommendations.
• Undergo peer review.
• Provide an explicit description of development of the guideline.
• Make of recommendations.
• Identify evidence.

• The identification of evidence.
• The creation of the recommendation.
• A combination of factors related to both the evidence and the recommendations.

• Barriers to implementation of guidelines may be environmental, financial, cultural, or related to a lack of knowledge regarding performance.
• Guidelines with clear recommendations, noncontroversial recommendations, and the use of evidence-based recommendations are more likely to be followed than guidelines with recommendations that were not clear, were controversial, or were based on opinion.

• The guideline needs to contain information that clearly defines the clinical situation for which the recommendations are applicable.
• The feasibility of implementing the intervention in the guideline should be determined.
• The clinician not only should know the evidence regarding different outcomes. To elicit the patient's value for different outcomes, the clinician first needs to fully inform the patient about these outcomes.

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