Strong Recommendations Are Inappropriate in Person-Centred Care: The Case of Anti-Platelet Therapy

Stud Health Technol Inform. 2019 Jul 4:262:110-113. doi: 10.3233/SHTI190029.

Abstract

A 'Rapid Recommendation' has been produced by the GRADE group, in collaboration with MAGIC and BMJ, in response to an RCT showing Dual Anti-Platelet Therapy (DAPT) is superior to Aspirin alone for patients who had suffered acute high risk transient ischaemic attack or minor ischaemic stroke. The interactive MAGIC decision aid that accompanies each Rapid Recommendation is the main route to their clinical implementation. It can facilitate preference-sensitive person-centred care, but only if a Multi-Criteria Decision Analysis-based decision support tool is added. A demonstration version of such an add-on to the MAGIC aid, divested of recommendations, is available online. Exploring the results of different preference inputs into the tool raises questions about the strong recommendation for DAPT.

Keywords: GRADE; MAGIC; Multi-Criteria Decision Analysis; anti-platelet therapy; person-centred decision support; preferences; transient ischaemic attack.

MeSH terms

  • Brain Ischemia* / drug therapy
  • Clopidogrel
  • Humans
  • Ischemic Attack, Transient* / drug therapy
  • Patient-Centered Care
  • Platelet Aggregation Inhibitors / therapeutic use
  • Stroke* / drug therapy

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel