H/A: Statement of Intent (2010)
Evidence-based nutrition practice guidelines are developed to help registered dietitians, practitioners, patients, families and consumers make shared decisions about health care choices in specific clinical circumstances. If properly developed, communicated and implemented, guidelines can improve care.
While the evidence-based nutrition practice guideline represents a statement of promising practice, based on the latest available evidence at the time of publication, the guideline is not intended to overrule professional judgment. Rather, it may be viewed as a relative constraint on the individual clinician's discretion in a particular clinical circumstance. The independent skill and judgment of the health care provider must always dictate treatment decisions. These nutrition practice guidelines are provided with the express understanding that they do not establish or specify particular standards of care, whether legal, medical or other.
The Role of Patient and Family Preference
This guideline recognizes the role of patient and family preferences for possible outcomes of care, when the appropriateness of a clinical intervention involves a substantial element of personal choice or values. With regard to types of evidence that are associated with particular outcomes, Shaughnessy and Slawson (1-3) describe two major classes. Patient-oriented evidence that matters (POEM) deals with outcomes of importance to patients, such as changes in morbidity, mortality or quality of life. Disease-oriented evidence (DOE) deals with surrogate end-points, such as changes in laboratory values or other measures of response. Although the results of DOE sometimes parallel the results of POEM, they do not always correspond.
When possible, ADA recommends using POEM-type evidence rather than DOE. When DOE is the only guidance available, the guideline indicates that key clinical recommendations lack the support of outcomes evidence.
- Slawson DC, Shaughnessy AF. Becoming an information master: using POEMs to change practice with confidence. Patient-Oriented Evidence that Matters. J Fam Pract. 2000 Jan; 49 (1): 63-67. Erratum in: J Fam Pract. 2000 Mar; 49 (3): 276.
- Slawson DC, Shaughnessy AF, Ebell MH, Barry HC. Mastering medical information and the role of POEMs--Patient-Oriented Evidence that Matters. J Fam Pract. 1997 Sep; 45 (3): 195-196.
- Shaughnessy AF, Slawson DC. POEMs: patient-oriented evidence that matters. Ann Intern Med. 1997 Apr 15; 126 (8): 667.
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