Optimizing clinical practice based on data, evidence and guidelines is a challenge faced in every health system around the world.

The way the challenge manifests itself at the level of the patient has been remarkably consistent over time:

tough decisions made at the intersection of clinical expertise, patient values and preferences, and the best available data, evidence and guidelines.(1) Rigid clinical decision support systems, insufficient attention to patient goals of care and shared decision-making (particularly in the face of multimorbidity), and the large volume of available data, evidence and guidelines (of variable reliability and clinical significance) are variations on a now twodecades-old theme about just how tough these decisions can be