As a framework, Braithwaite et al1 offer a useful tool for quantifying risk and harm for a particular type of clinical guideline—one in which the benefit occurs subsequent to the harm. They cite colonoscopy as an example. Furthermore, they state that this condition (ie, benefit following harm) occurs often in clinical practice guidelines. This may be overstating the case. While the tool is conceptually useful (and I will use it), this type of practice recommendation probably represents a small fraction of the relevant clinical practice guideline recommendations that physicians must consider when caring for older adults with multiple chronic illnesses. For example, in the study by Boyd et al,2 a significant proportion of the recommendations for 10 of the most prevalent diseases in older adults (eg, hypertension, chronic heart failure, stable angina, atrial fibrillation, hypercholesterolemia, diabetes mellitus, osteoarthritis, chronic obstructive pulmonary disease, and osteoporosis) involved long-term medication use and long-term behavioral changes.2 For these interventions, harms or burdens are continuous and may be cumulative. A knottier challenge remains: creating a decision support tool that helps physicians caring for patients with multiple chronic conditions prioritize interventions that are most beneficial and relevant within the context of these patients' lives.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.