Clinical decision making: from theory to practice. Designing a practice policy. Standards, guidelines, and options

DESIGNING a practice policy is similar to making a decision for an individual patient. In both cases, one must identify the available options, estimate the consequences of the different options, and determine the desirability of those outcomes to patients. Practice policies can be thought of as generic decisions—recommendations intended for a collection of patients rather than for a single patient. Beyond these similarities, however, are some important differences that make practice policies considerably more difficult to design. In the case of a decision, the outcomes and preferences apply to a particular patient. There might be a range of uncertainty about the outcomes, the comparisons might be difficult, and there will be varying degrees of conviction about which option is best, but, in theory at least, there is a single option that is best for that patient. Practice policies are inherently more difficult because they attempt to make decisions for a