Advantages of developing clinical practice guidelines using international standards.

The American Psychological Association (APA) recently adopted three clinical practice guidelines (CPGs), including one on the treatment of posttraumatic stress disorder that engendered considerable controversy because it recommended several trauma-focused therapies that have been extensively tested but not that widely practiced and not other forms of treatment that are widely practiced but not extensively tested. Concerns have been raised that the guideline hewed too closely to procedures established by the Institute of Medicine (IOM) and relied too exclusively on efficacy data from randomized controlled trials. Both the IOM model and the APA’s evidence-based practice model recommend basing treatment decisions on the best available scientific evidence as channeled through clinical expertise in a manner consistent with patient values and preferences. Despite this shared framework, questions remain as to how to prioritize different sources of evidence and how much weight to give methodologies other than randomized controlled trials. We describe the need for CPGs and the APA’s reasons for following the rigorous procedures recommended by the IOM. We also describe our hope that future CPGs will consider a broader range of scientific evidence and better integrate clinical expertise in the guideline text to provide context for applying their recommendations. This will enable discussion of treatments that are often excluded from systematic reviews and recognize the importance of individualizing care. These proposed updates to the guideline development process would allow CPGs to stay true to the rigor reflected in the IOM standards, while more fully recognizing the contributions of a wider range of evidence bases. (PsycINFO Database Record (c) 2019 APA, all rights reserved)