Medical Facts vs. Value Judgments

Abstract

To the Editor: In his Perspective article (June 25 issue), 1 Ubel contends that the National Com-prehensive Cancer Network (NCCN) guidelines fail to consider patient preferences and values. Clinical practice guidelines are designed to assist physicians and patients in decision making in specific clinical circumstances and do not re-move the physician's or patient's autonomy in decision making, nor do they eliminate the need for shared decision making between patient and physician. The NCCN guidelines were the first in oncology to incorporate patient preference in de-cision making. Patient advocates with full voice and vote serve on many NCCN guidelines panels, transparency procedures are in place, and the NCCN has patient versions of selected guide-lines. The NCCN is developing evidence blocks to provide patients and physicians with additional information that will stimulate discussion on pa-tient preferences and values. These evidence blocks provide information on options for ther-apy, including efficacy, safety (toxicity), quality of data, consistency of data, and affordability (cost). The NCCN shares Ubel's conviction that patient preferences and values should be incorporated into the application of clinical practice guide-lines and is actively evolving the NCCN guide-lines to better accomplish that goal.