Abstract for: What is the Stakeholder Effect on Clinical Guideline Formation Process: An Experimental Study

Clinical guidelines have been varying significantly over time in the United States. Karanfil and Sterman (2020) propose an endogenous theory of guideline oscillations. Their stylized model suggests that oscillations occur even with a single evidence-based guideline. Policy decision thresholds cycle over time due to the delay in and between policy formation and implementation. We replicate the authors’ original model, their extended case study, and formal model for the PSA screening for the U.S. We conduct additional sensitivity analyses and propose an experimental platform to test the proposed oscillatory behavior exploring the effect of having multiple stakeholders particularly specialty-advocacy groups. We show that advocacy groups in many cases exacerbate the oscillations resulting in more deviations from evidence-based guidelines. We propose an experimental study (i) to test the original theory of guidelines oscillation and (ii) to assess the effect of the extended model with multiple stakeholders. We plan to randomly frame participants into two, assuming the role of either policymaker (i.e., representative of guideline issuing organizations) or advocacy group leader. We aim to test whether the advocacy groups' decisions will amplify the oscillations.