When Patients Write the Guidelines: Patient Panel Recommendations for the Treatment of Rheumatoid Arthritis.

OBJECTIVE: How best to involve patients in the development of clinical practice guideline (CPG) recommendations is not known. We sought to determine the feasibility and value of developing CPG recommendations based on a voting panel composed entirely of patients, with the ultimate goal of comparing the patients' recommendations to ones developed by a physician-dominated voting panel on the same clinical questions. METHODS: Ten patients with rheumatoid arthritis completed 8 hours of training on evidence-based medicine and guideline development. They constituted a voting panel and, with 2 American College of Rheumatology staff with expertise in CPG development and a physician facilitator, subsequently met at a face-to-face meeting to develop recommendations. They applied the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to formulate recommendations on 18 questions for which there was evidence warranting moderate or high confidence. RESULTS: The patient panel developed recommendations for 16 of the 18 questions; for the other 2, the panel thought there were insufficient data to support a recommendation. For 13 of the 16 questions, the patient panel recommended the same course of action as did the physician-dominated panel. Differences were due to how the 2 panels valued the balance between benefits and harms. CONCLUSION: Patient and physician-dominated panels developed the same recommendations for most questions for which there was evidence warranting moderate to high confidence. Additional experiences are necessary to advance the evidence necessary to determine what panel composition is optimal to produce the best guidelines.

"If you can't say something nice, don't say anything at all": coping with interpersonal tensions in the parent-child relationship during adulthood.

Tensions are normative in the parent-child tie, but there is less information on the strategies used to cope with such tensions. This study examined strategies parents and adult children use in reaction to interpersonal tensions and the implications of those strategies for relationship quality. Parents and their adult sons and daughters (aged 22 to 49 years; N = 158 families, 474 individuals) reported the strategies they used in response to tensions with one another (constructive, destructive, and avoidant). Across dyads, parents and adult children reported using constructive strategies more often than destructive or avoidant strategies. Strategy use varied between and within dyads by generation, gender of parent, ethnicity, education, and age of child. Constructive strategies predicted better relationship quality, whereas avoidant and destructive strategies predicted poorer relationship quality. Parents may be more likely to use constructive strategies, which are meant to maintain the relationship because of their greater investment in the tie. (PsycINFO Database Record (c) 2009 APA, all rights reserved).