BMJ: Treatment burden should be included in clinical practice guidelines

19 October, 2018

'The work that patients do to manage their health often remains invisible to health professionals', says this analysis paper in this week's print BMJ (20 October)

CITATION: Dobler Claudia C, Harb Nathan, Maguire Catherine A, Armour Carol L, Coleman Courtney, Murad M Hassan et al. Treatment burden should be included in clinical practice guidelines BMJ 2018; 363 :k4065. (restricted access)

Correspondence to: C C Dobler dobler.claudia AT

Key messages:

- Treatment burden, the work that patients need to do to care for their health and its effect on their life, is often substantial for people with chronic conditions

- Although modern clinical guidelines may consider acceptability to patients, evaluations of treatment burden are not included

- Information on treatment burden would enable patients to make informed decisions about treatments

- High quality methods for assessing treatment burden need to be identified and meaningful ways of adding this information to clinical practice guidelines need to be explored.

Comment (Neil PW): Although the paper does not appear to mention it, this problem is likely to be closely related to overdiagnosis and overtreatment. If a treatment is effective, most patients would be willing to invest 'work'. It a treatment is ineffective or harmful, then the patient's need to invest 'work' adds insult to injury.

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA:

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 18,000 members in 177 countries, interacting on five global forums in three languages. He also currently chairs the Dgroups Foundation (, which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: