Paper long abstract:

Developers of clinical practice guidelines face the challenge of how to include dimensions of care that are not easily articulated in evidence-based terms. Although evidence-based guideline development does not exclude any clinical issues or types of knowledge per se, guideline development groups face substantial challenges when attempting to integrate different knowledges. This makes guideline development an interesting site to study how judgment and calculation are brought together by what Callon and Law have called 'rendering issues qualculable'. To do so, we study the development of two guidelines on suicidality and contrast their development practices and resulting textual arrangements. Developers face the tricky tension between articulating the importance of 'making contact' with suicidal people, and the pressure to use risk assessment instruments. Such risk assessment tools directly problematize making contact, but are hard to exclude in the light of available evidence. Developers of the two guidelines either try to qualculate contact within the spatiotemporal frame of evidence-based guideline development, or try to articulate this issue in ways that are more suiting to the issue of making contact, but require another spatiotemporal frame. 'Knowledge integration' in guideline development therefore requires not just a focus on practices of qualculation; it equally requires reflection on the affordances of spatiotemporal frames, as historically grown environments, for articulating the issues at hand. This is relevant for ongoing discussions within Science and Technology Studies in relation to the question of how to articulate issues, render them accountable and still foster diversity by affording discontinuity when doing standards.