Give us clear, not convoluted, clinical practice guidelines
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* John Sehmer

After reading the guideline on chemoprevention of breast cancer,1 I feel compelled to vent my frustration at the publication of yet another verbose, convoluted and impractical guideline for those of us in clinical practice to follow. The appendix entitled “Questions and answers on chemoprevention and breast cancer: a guide for women and their physicians” also seems totally impractical. The woman and her physician are advised to obtain the Gail index from a Web site but told that it will only be useful in determining “whether to further discuss the benefits and harms of taking tamoxifen.” A woman is supposed to decide whether she feels “a tamoxifen-induced stroke would be far worse than breast cancer” or “breast cancer would be far worse than a stroke.” She is then advised, “You will have to determine the value you place on the possible consequences of taking or not taking tamoxifen after a full discussion with your doctor.” Like so many other *CMAJ* guidelines, this provides little assistance in the decision-making process for the physician or the patient. Am I supposed to ask my patients if they would prefer to die of breast cancer or a tamoxifen-induced stroke?

I suggest that consensus documents be limited to 4 or 5 pages in length; they should be concise in their recommendations and should not obfuscate areas that are unclear. Peer reviewers should include clinicians and community practitioners. If the guideline document is unclear, ambiguous or unhelpful it should be sent back to the authors for revision.

Consensus documents and clinical practice guidelines are a great idea. Please keep publishing them, but always consider whether the recommendations are clear, useful and practical. Recommendations that a therapy should be used only in cases in which the potential benefits outweigh the risks are not helpful when the potential risks and benefits have not been outlined clearly.

## Reference

1.  1. Levine M, Moutquin JM, Walton R, Feightner J. Chemoprevention of breast cancer. CMAJ 2001; 164(12):1681-90.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTY0LzEyLzE2ODEiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTY1LzExLzE0NjguMy5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)