Guidelines for Guidelines: Are They Up to the Task? A Comparative Assessment of Clinical Practice Guideline Development Handbooks

Old Dominion University, United States of America
PLoS ONE (Impact Factor: 3.23). 11/2012; 7(11):e49864. DOI: 10.1371/journal.pone.0049864
Source: PubMed


We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks.
We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as 'necessary' tasks.
Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks' weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors.
Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings help decision makers in identifying the necessary tasks for guideline development, provide an updated comparative list of guideline development handbooks, and provide a checklist to assess the comprehensiveness of guideline development processes.

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Available from: Arash Rashidian, Oct 20, 2014
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    • "In recent years, clinical guidelines have come under increased scrutiny, being accused of a lack of transparency, bias arising from panel members' relationships with industry (RWI) and associated conflicts of interest (COI), and confusion caused by different sets of recommendations being produced in answer to the same clinical question [4] [5] [6] [7]. Similarly, the approach adopted by specialty societies to develop their clinical guidelines has been questioned, if not doubted, because they do not use a multidisciplinary panel approach to reduce the risk of bias when formulating recommendations [8]. As a result of these critiques, there have been calls for radical reform in the way in which guidelines are produced to allow for the return of trust [9]. "
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    ABSTRACT: The goal of all clinical guidelines is to assist patients and practitioners in making healthcare decisions. However, clinical guidelines have been questioned about their quality, transparency and independence. Based on the revision of manuals by other scientific cardiothoracic organizations, this document provides instructions for the development of European Association for Cardio-Thoracic Surgery (EACTS) clinical guidelines and other types of evidence-based documents. Four key areas have been addressed: (i) selection of taskforce members and transparency of relations with the industry, (ii) methods for critical appraisal of medical evidence, (iii) rules for writing recommendations and (iv) review process. It is hoped that, by adopting this methodology, clinical guidelines produced by the EACTS will be well balanced, objective and, importantly, trusted by physicians and patients who benefit from their implementation.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2015; 48(6). DOI:10.1093/ejcts/ezv309 · 3.30 Impact Factor
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    • "1 These initiatives are aimed at ensuring CPGs are congruent with evidence-based methodologies in knowledge synthesis and dissemination, are based on the most robust and current evidence, and are appropriate for professional practice (Alonso- Coello et al., 2010; Ansari & Rashidian, 2012; Blozik et al., 2012; Cahil & Heyland, 2010; Davis & Taylor-Vaisey, 1997; Grol, 2001; Norris, Holmer, Ogden, & Burda, 2011; Parry et al., 2003). Indeed, methodological rigor during the guideline development process has been shown to influence the implementation of the guidelines and their use in practice (Alonso-Coello et al., 2010; Ansari & Rashidian, 2012; Blozik et al., 2012; Cahil & Heyland, 2010; Davis & Taylor-Vaisey, 1997; Grol, 2001; Norris et al., 2011). In addition, the quality of guidelines has been found to be associated with positive intervention outcomes in medicine and the social sciences (Burgers, Cluzeau, Hanna, Hunt, & Grol, 2003; Gordon & Cooper, 2010; Grimshaw & Russell, 1993). "
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    ABSTRACT: Despite the availability and proliferation of clinical practice guidelines (CPGs) and of methods to design such guidelines in recent years, a growing body of evidence suggests that the quality of CPGs can often be dubious, typically pointing to a lack of methodological rigor in guideline development. In the social sciences and in psychology, numerous CPGs have been developed, yet research has failed to investigate their quality and methodology. This pilot study evaluated the 5 available guidelines of the Order of Psychologists of Quebec (OPQ) using a scoring system proposed by Ansari and Rashidian (2012) for examining guideline development tasks. The method consisted of rating CPGs based on the absence, presence, or detailed consideration of 27 tasks involved in guideline development. Overall, results suggest that the CPGs did not implement important tasks for guideline development, and were far below the acceptable standards in guideline development procedures. A minimal number of the necessary tasks for guideline development were addressed in the CPGs. These findings suggest there are important problems with the development and quality of these CPGs. The pilot study also points to the need for conducting future research on the clinical guidelines used in psychology.
    08/2014; 5(3):177-186. DOI:10.1037/a0037287
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    • "In 2010, AGREE II was translated into Korean and distributed to Korean medical societies. The usefulness of AGREE II have been verified through various quality assessment studies of specific diseases (8, 9, 10, 11), international comparison of the level of guideline development (12, 13), and overall quality assessment of CPGs developed in specific countries (14, 15, 16, 17). "
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    ABSTRACT: The Korean translated Appraisal of Guidelines for Research and Evaluation II (Korean AGREE II) instrument was distributed into Korean medical societies in 2011. However, inter-rater disagreement issues still exist. The Korean AGREE II scoring guide was therefore developed to reduce inter-rater differences. This study examines the effects of the Korean AGREE II scoring guide to reduce inter-rater differences. Appraisers were randomly assigned to two groups (Scoring Guide group and Non-Scoring Guide group). The Korean AGREE II instrument was provided to both groups. However, the scoring guide was offered to Scoring Guide group only. Total 14 appraisers were participated and each guideline was assessed by 8 appraisers. To evaluate the reliability of the Korean AGREE II scoring guide, correlation of scores among appraisers and domain-specific intra-class correlation (ICC) were compared. Most scores of two groups were comparable. Scoring Guide group showed higher reliability at all guidelines. They showed higher correlation among appraisers and higher ICC values at almost all domains. The scoring guide reduces the inter-rater disagreement and improves the overall reliability of the Korean-AGREE II instrument. Graphical Abstract
    Journal of Korean Medical Science 06/2014; 29(6):771-5. DOI:10.3346/jkms.2014.29.6.771 · 1.27 Impact Factor
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