Stakeholder bias in best practice advisories: an ethical perspective

Clinicians are increasingly being asked to heed and follow the guidance provided by “best practice advisories.” Such advisories, often in the form of electronic reminders or alerts, are meant to increase the efficiency and effectiveness of evidence-based medical practice. However, we argue that best practice advisories can sometimes be infused with stakeholder bias, even if inadvertently. We specifically argue that best practice advisory biases can occur when an advisory is not oriented to benefit patients at least as much or more than other stakeholders. To address this issue, we put forth the perspective that ethical consideration of biases is especially important in best practice advisory design and revision processes.