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Choufani M, Kay J, Ermann J. Axial spondyloarthritis guidelines - aiming for maximum impact. Curr Opin Rheumatol 2024:00002281-990000000-00116. [PMID: 38661436 DOI: 10.1097/bor.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW This review discusses international clinical practice guidelines (CPGs) for axial spondyloarthritis (axSpA) focusing on methodology, guideline quality, and implementation. RECENT FINDINGS The Assessment of SpondyloArthritis International Society/European Alliance of Associations for Rheumatology (ASAS/EULAR) and Pan-American League of Associations for Rheumatology (PANLAR) recently published axSpA CPGs and updates of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network (ACR/SAA/SPARTAN) and Asia-Pacific League of Associations for Rheumatology (APLAR) CPGs are expected. GRADE has emerged as the dominant framework for CPG development and has been used by three of the four international axSpA guidelines. Notable differences exist among these guidelines in the way that the recommendations are presented. Two of the four acknowledge the need for implementation strategies, but little detail about this is provided. The few studies that have evaluated the implementation of axSpA CPGs have identified poor adherence to recommendations on physical therapy/exercise and disease activity monitoring. Implementation science has identified many barriers and facilitators affecting guideline uptake, including those related to healthcare professionals and to the guidelines themselves. Creation of a tailored implementation plan simultaneously with the CPG is recommended. SUMMARY While methodological rigor in the creation of evidence-based recommendations is the focus of CPG development, recommendations must be presented in a user-friendly format that makes them easy to apply. 'Living guidelines' could facilitate keeping content up to date. Implementation is critical for the success of a CPG and should be emphasized in future axSpA guideline updates. Further research is needed to better understand the factors impacting the successful implementation of axSpA CPGs.
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Affiliation(s)
| | - Jonathan Kay
- UMass Chan Medical School and UMass Memorial Medical Center, Worcester
| | - Joerg Ermann
- Brigham and Women's Hospital, Boston
- Harvard Medical School, Boston, Massachusetts, USA
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Oliveira J E Silva L, Bellolio F, Carpenter CR. Clinical relevance rather than evidence existence: The SAEM GRACE pragmatism. Acad Emerg Med 2024. [PMID: 38594826 DOI: 10.1111/acem.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Oerbekke MS, Gaasterland CMW, van der Laan MJ, Hooft L. Introducing re-weighted range voting in clinical practice guideline prioritization: Development and testing of the re-weighted priority-setting (REPS) tool. PLoS One 2024; 19:e0300619. [PMID: 38578723 PMCID: PMC10997121 DOI: 10.1371/journal.pone.0300619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/03/2024] [Indexed: 04/07/2024] Open
Abstract
We aimed to develop and test a tool based on the re-weighted range voting mechanism to prioritize items (i.e. key questions) in a priority-setting assessment for clinical practice guidelines. The secondary aim was to provide methodological context of the tool. We iteratively developed the tool and used qualitative methods (i.e. think-aloud and semi-structured interviews) to test the tool's usability and make adjustments accordingly. An observational approach was used to test the tool's outcome satisfaction in a real-world priority-setting assessment within a rare-disease guideline of a European Reference Network and under four different conditions in the tool. Four guideline methodologists tested the usability of the tool. The real-world testing was performed with a guideline panel consisting of a core working group, five expertise working groups, and a working group with patient representatives. Thirty-one panel members assigned scores in the priority-setting assessment. Seventeen panel members rated the priority-setting outcome, and sixteen panel members rated the outputs generated under the four conditions. Upon initial use, guideline methodologists found the tool to be quite overwhelming. However, with some initial effort they were able to easily identify the tool's structure. Based on observations and feedback, the tool was further refined and user guidance was developed. Guideline panel members expressed (high) satisfaction with the priority-setting outcome. They particularly preferred the condition when using mean subgroup scores as input or employing aggressive penalties in the weighting method to determine the outputs. The tool generates a ranked list of items and offers flexibility for different choices in priority-setting assessments as long as its input format requirements are met. Although it is not a consensus method, the tool assists in narrowing down a set of priority items. Additional steps in the priority-setting assessment can lead to a consensus being reached regarding the final outcome.
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Affiliation(s)
- Michiel S. Oerbekke
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Charlotte M. W. Gaasterland
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
- Emma Center for Personalized Medicine, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Külper-Schiek W, Thielemann I, Pilic A, Meerpohl JJ, Siemens W, Vygen-Bonnet S, Koch J, Harder T, Piechotta V. Needs and feasibility of living systematic reviews (LSRs): Experience from LSRs on COVID-19 vaccine effectiveness. Z Evid Fortbild Qual Gesundhwes 2024:S1865-9217(24)00007-2. [PMID: 38519357 DOI: 10.1016/j.zefq.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 03/24/2024]
Abstract
During 2021 and 2023, a team of researchers at the Robert Koch Institute (RKI) and partnering institutions conducted two living systematic reviews (LSRs) on the effectiveness of COVID-19 vaccines in different age groups to inform recommendations of the Standing Committee on Vaccination in Germany (Ständige Impfkommission, STIKO). Based on our experience from the realization of these LSRs, we developed certain criteria to assess the needs and feasibility of conducting LSRs. Combining these with previously established criteria, we developed the following set to inform future planning of LSRs for STIKO: Needs criterion (N)1: Relevance of the research question, N2: Certainty of evidence (CoE) at baseline; N3: Expected need for Population-Intervention-Comparator-Outcome (PICO) adaptations; N4: Expected new evidence over time; N5: Expected impact of new evidence on CoE; Feasibility criterion (F)1: Availability of sufficient human resources; F2: Feasibility of timely dissemination of the results to inform decision-making. For each criterion we suggest rating options which may support the decision to conduct an LSR or other forms of evidence synthesis when following the provided flowchart. The suggested criteria were developed on the basis of the experiences from exemplary reviews in a specific research field (i.e., COVID-19 vaccination), and did not follow a formal development or validation process. However, these criteria might also be useful to assess whether questions from other research fields can and should be answered using the LSR approach, or assist in determining whether the use of an LSR is sensible and feasible for specific questions in health policy and practice.
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Affiliation(s)
| | | | - Antonia Pilic
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Waldemar Siemens
- Institute for Evidence in Medicine, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | | | - Judith Koch
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Berlin, Germany
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Siemens W, Mahler S, Schaefer C, Nothacker M, Piechotta V, Prien P, Schüler S, Schwarz S, Blödt S, Thielemann I, Harder T, Kapp P, Labonté V, Meerpohl JJ, Braun C. [Development of criteria for the prospective assessment of the need for updating guideline recommendations: The AGIL criteria]. Z Evid Fortbild Qual Gesundhwes 2024; 184:7-17. [PMID: 38238131 DOI: 10.1016/j.zefq.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Evidence-based guideline and vaccination recommendations should continuously be updated to appropriately support health care decisions. However, resources for updating guidelines are often limited. The aim of this project was to develop a list of criteria for the prospective assessment of the need for updating individual guideline or vaccination recommendations, which can be applied from the time a guideline or guideline update is finalised. METHODS In this article we describe the development of the AGIL criteria (Assessment of Guidelines for Updating Recommendations). The AGIL criteria were developed by experienced scientists and experts in the field of guideline development in a multi-step process. The five steps included: 1) development of an initial list of criteria by the project team; 2) online survey of guideline experts on the initial version of the criteria list; 3) revision of the criteria list based on the results of the online survey; 4) workshop on the criteria list at the EbM Congress 2023; 5) creation of version 1.0 of the AGIL criteria based on the workshop results. RESULTS The initial list included the following three criteria: 1) relevance of the question 2) availability of new relevant evidence, and 3) impact of potentially new evidence. The response rate of the online survey for fully completed questionnaires was 31.0% (N=195; 630 guideline experts were contacted by email). For 90.3% (n=176) of the respondents, the criteria list included all essential aspects for assessing the need for updating guideline recommendations. More than three quarters of respondents rated the importance of the three criteria as "very important" or "important" (criteria 1-3: 75.3%, 86.1%, 85.2%) and - with the exception of criterion 1 - comprehensibility as "very comprehensible" or "comprehensible" (criteria 1-3: 58.4%, 75.9%, 78.5%). The results of the online survey and the workshop generally confirmed the three criteria with their two sub-questions. The incorporation of all feedback resulted in the AGIL criteria (version 1.0), recapping: 1) relevance of the question regarding a) PICO components and b) other factors, e.g. epidemiological aspects; 2) availability of new evidence a) on health-related benefits and harms and b) on other decision factors, e.g. feasibility, acceptability; 3) impact of new evidence a) on the certainty of evidence on which the recommendation is based and b) on the present recommendation, e.g. STRENGTH OF RECOMMENDATION DISCUSSION The moderate response rate of the online survey may have limited its representativeness. Nevertheless, we consider the response rate to be satisfactory in this research context. The inclusion of many experts in the online survey and the EbM Congress workshop is a strength of the project and supports the quality of the results. CONCLUSIONS The AGIL criteria provide a structured guidance for the prospective assessment of the need for updating individual guideline recommendations and other evidence-based recommendations. The implementation and evaluation of the AGIL criteria 1.0 in a field test is planned.
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Affiliation(s)
- Waldemar Siemens
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland.
| | - Sonja Mahler
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Corinna Schaefer
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement (AWMF-IMWi), Marburg, Deutschland
| | | | - Peggy Prien
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Sabine Schüler
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Sabine Schwarz
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
| | - Susanne Blödt
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement (AWMF-IMWi), Marburg, Deutschland
| | | | | | - Philipp Kapp
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Valérie Labonté
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
| | - Joerg J Meerpohl
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
| | - Cordula Braun
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
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Tummers F, Coppus S, Lagerveld B, Demirkiran A, van Schrojenstein Lantman E, Brouwer T, Draaisma W, Jansen F. Efficiency based updating of evidence based surgical guidelines - Experiences from a multidisciplinary guideline upon Minimally Invasive Surgery. Facts Views Vis Obgyn 2023; 15:215-224. [PMID: 37742198 PMCID: PMC10643014 DOI: 10.52054/fvvo.15.3.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Updating evidence-based clinical practice guidelines is an onerous process and there is a call for more efficient determination of key questions that need updating. Especially for surgical techniques it is unclear if new evidence will result in substantial changes after wide implementation and if continuous updating is always necessary. Objectives This study analyses the impact of updating a surgical guideline and proposes suggestions for optimising this process. Materials and methods The Dutch Minimally Invasive Surgery guideline was developed in 2011 and updated in 2021. For both versions a multidisciplinary guideline working group (GDG) was created, that determined key questions. Changes in conclusions and recommendations were analysed by the GDG and statements for expected change of recommendations in the future were made. Results 15 key questions were formed, of which 12 were updates of the previous guideline. For only 27% of the updated key questions, the conclusions changed. In ten years, the body grew only marginally for most key questions and quality of the evidence did not improve substantially for almost all key questions. However, in this first update of the MIC guideline, many recommendations did change due to a more robust interpretation of the conclusions by the GDG. Based on analysis of this updating process, the GDG expects that only four out of 15 recommendations may change in the future. Conclusion We propose an additional step at the end of guideline development and updating, where the necessity for updating in the future is determined for each key question by the GDG, using their valuable knowledge gained from developing or updating the guideline. For surgical guidelines, the authors suggest updating key issues if it includes a relatively newly introduced surgical- or adapted technique or a new patient group. Low quality or small body of evidence should not be a reason in itself for updating, as this mostly does not lead to new evidence-based conclusions. This new step is expected to result in a more efficient prioritising of key questions that need updating. What’s new? By adding one additional step at the end of the updating process, the future updating process could become more efficient.
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Affiliation(s)
- F.H.M.P. Tummers
- Department of Gynecology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - S.F.P.J. Coppus
- Department of Gynecology, Maxima Medical Center, 5631 BM Veldhoven/Eindhoven, The Netherlands
| | - B.W. Lagerveld
- Department of Urology, OLVG, 1091 AC Amsterdam, The Netherlands
| | - A Demirkiran
- Department of Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | | | - T.A. Brouwer
- Department of Anesthesiology, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - W.A. Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 5223 GZ Den Bosch, The Netherlands
| | - F.W. Jansen
- Department of Gynecology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
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Gühne U, Weitzel EC, Schladitz K, Löbner M, Soltmann B, Jessen F, Schmitt J, Pfennig A, Riedel-Heller SG. [Expectations of guideline developers on living guidelines]. Nervenarzt 2023:10.1007/s00115-023-01476-6. [PMID: 37138092 DOI: 10.1007/s00115-023-01476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Guidelines are central pillars of high-quality care and care planning. The quality requirements for the development of guidelines and the associated effort are very high. Therefore, more efficient approaches are being forced. OBJECTIVE The opportunities and challenges in the introduction of a dynamic updating concept within the framework of the digitalization of guidelines were explored from the perspective of guideline developers in the field of psychiatry. This perspective should be included in the implementation. MATERIAL AND METHODS Between January and May 2022 a cross-sectional survey was conducted among guideline developers (N = 561, response 39%) based on a questionnaire developed and tested in advance. Data were analyzed descriptively. RESULTS A total of 60% were familiar with the concept of living guidelines. A large proportion endorsed a dynamic updating (83%) and digitalization (88%) of guidelines; however, various challenges are associated with the concept of living guidelines: the risk of inflationary changes (34%), the need for continuity of all actors (53%), involvement of patient and family representatives (37%) and definition of criteria regarding the decision what to change (38%). The vast majority (85%) thought it necessary that guideline development should be followed by implementation projects. CONCLUSION German guideline developers are very receptive regarding the implementation of living guidelines; however, they named numerous challenges, which need to be addressed in this approach.
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Affiliation(s)
- Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland.
| | - Elena C Weitzel
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - Katja Schladitz
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - Margrit Löbner
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| | - Bettina Soltmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Frank Jessen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät der Uniklinik Köln, Köln, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
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Kok-Pigge AC, Greving JP, de Groot JF, Oerbekke M, Kuijpers T, Burgers JS. A Delphi consensus checklist helped assess the need to develop rapid guideline recommendations. J Clin Epidemiol 2023; 156:1-10. [PMID: 36764465 DOI: 10.1016/j.jclinepi.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVES We aimed to develop a checklist to aid guideline developers in determining which scientific or societal cause ("triggers") are relevant when considering to initiate a rapid recommendation procedure. METHODS We conducted a two-round modified Delphi procedure with a panel of Dutch guideline experts, clinicians, and patient representatives. A previously conducted systematic literature review and semistructured interviews with four science journalists were used to generate a list of potential items. This item list was submitted to the panel for discussion, reduction and refinement into a checklist. RESULTS Thirteen experts took part. Two questionnaires were completed in which participants scored an initial list of 64 items based on relevance. During two online meetings, the scores were discussed, irrelevant items were removed, and relevant items were reformulated into seven questions. The final "quickscan assessment of the need for a rapid recommendation" covers user perspective, scientific evidence, clinical relevance, clinical practice variation, applicability, quality of care and public health outcomes, and ethical/legal considerations. CONCLUSION The quickscan aids guideline developers in systematically assessing whether a trigger expresses a valid need for developing a rapid recommendation. Future research could focus on the applicability and validity of the checklist within guideline development programs.
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Affiliation(s)
- Aimee Claire Kok-Pigge
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands.
| | - Jacoba P Greving
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Janke F de Groot
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Michiel Oerbekke
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Ton Kuijpers
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Jako S Burgers
- Dutch College of General Practitioners, Domus Medica, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
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Cheyne S, Fraile Navarro D, Buttery AK, Chakraborty S, Crane O, Hill K, McFarlane E, Morgan RL, Mustafa RA, Poole A, Tunnicliffe D, Vogel JP, White H, Whittle S, Turner T. Methods for living guidelines: early guidance based on practical experience. Paper 3: selecting and prioritizing questions for living guidelines. J Clin Epidemiol 2023; 155:73-83. [PMID: 36603743 DOI: 10.1016/j.jclinepi.2022.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This article is part of a series on methods for living guidelines, consolidating practical experiences from developing living guidelines. It focuses on methods for identification, selection, and prioritization of clinical questions for a living approach to guideline development. STUDY DESIGN AND SETTING Members of the Australian Living Evidence Consortium, the National Institute of Health and Care Excellence and the US Grading of Recommendations, Assessment, Development and Evaluations Network, convened a working group. All members have expertize and practical experience in the development of living guidelines. We collated methods, documents on prioritization from each organization's living guidelines, conducted interviews and held working group discussions. We consolidated these to form best practice principles which were then edited and agreed on by the working group members. RESULTS We developed best practice principles for (1) identification, (2) selection, and (3) prioritization, of questions for a living approach to guideline development. Several different strategies for undertaking prioritizing questions are explored. CONCLUSION The article provides guidance for prioritizing questions in living guidelines. Subsequent articles in this series explore consumer involvement, search decisions, and methods decisions that are appropriate for questions with different priority levels.
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Affiliation(s)
- Saskia Cheyne
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
| | - David Fraile Navarro
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Samantha Chakraborty
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Olivia Crane
- National Institute of Health and Care Excellence, Manchester, UK
| | | | - Emma McFarlane
- National Institute of Health and Care Excellence, Manchester, UK
| | - Rebecca L Morgan
- Evidence Foundation, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, McMaster, Canada
| | - Reem A Mustafa
- Evidence Foundation, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, McMaster, Canada; University of Kansas Medical Center, KS, USA
| | - Alex Poole
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - David Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Joshua P Vogel
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Maternal, Child and Adolescent Health Program, Burnet Institute, Australia
| | - Heath White
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel Whittle
- Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network, Melbourne, Australia; The Queen Elizabeth Hospital, South Australia, Australia; Department of Epidemiology and Preventive Medicine, School of Preventive Medicine and Public Health, Monash University, Melbourne, Australia
| | - Tari Turner
- Australian Living Evidence Consortium, Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Sultan S, Siedler MR, Morgan RL, Ogunremi T, Dahm P, Fatheree LA, Getchius TSD, Ginex PK, Jakhmola P, McFarlane E, Murad MH, Temple Smolkin RL, Amer YS, Alam M, Kang BY, Falck-Ytter Y, Mustafa RA. An International Needs Assessment Survey of Guideline Developers Demonstrates Variability in Resources and Challenges to Collaboration between Organizations. J Gen Intern Med 2022; 37:2669-2677. [PMID: 34545466 PMCID: PMC9411275 DOI: 10.1007/s11606-021-07112-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/20/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. OBJECTIVE To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. DESIGN Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. PARTICIPANTS A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. MAIN MEASURES The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents' perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. KEY RESULTS Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5-7). In-house resources to conduct literature searches (median=4; IQR=3-6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2-5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4-7) and the time required to establish collaborative agreements (median=6; IQR=5-6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. CONCLUSION The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations.
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Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, MN, USA.
| | - Madelin R Siedler
- Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Rebecca L Morgan
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Toju Ogunremi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Philipp Dahm
- Department of Urology, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, MN, USA
| | | | - Thomas S D Getchius
- Guideline Strategy and Operations, American Heart Association and American College of Cardiology, Dallas, TX, USA
| | - Pamela K Ginex
- Evidence-Based Practice, Oncology Nursing Society, Pittsburgh, PA, USA
| | - Priya Jakhmola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - M Hassan Murad
- Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Yasser S Amer
- Pediatrics, Quality Management, King Saud University Medical City, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yngve Falck-Ytter
- Gastroenterology Seection, VA Northeast Ohio Healthcare System, Case Western Reserve University, Cleveland, OH, USA
| | - Reem A Mustafa
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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11
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Goossen K, Bieler D, Hess S, Becker M, Kalsen M, Flohé S, Pieper D. An adapted 'Ottawa' method allowed assessing the need to update topic areas within clinical practice guidelines. J Clin Epidemiol 2022; 150:1-11. [PMID: 35710055 DOI: 10.1016/j.jclinepi.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To adapt and evaluate a method for assessing the need to update guideline topic areas involving multiple recommendations. STUDY DESIGN AND SETTING The 'Ottawa method' uses literature signals to determine changes in evidence that trigger a need to update individual guideline questions. We adapted the Ottawa method to include a process for aggregating updating signals by topic area (e.g., resuscitation) and tested this method using the German guideline on the treatment of patients with severe/multiple injuries. This involved a focused systematic evaluation of current evidence to identify updating signals, and classifying the need to update for each topic area. Then, we surveyed the guideline group online about the modified method. RESULTS We conducted focused literature searches for 37 topic areas and screened a mean of 97 abstracts per topic area in 2021. The need to update was high for eight (21.6%), intermediate for eight (21.6%), and low for 21 topic areas (56.8%) based on updating signals. The survey response rate was 56% (24/43). Most guideline group members (94%, 16/17 responders) would use the Ottawa method again, but their comments identified some weaknesses. CONCLUSION The modified Ottawa method is a suitable, efficient tool to generate evidence-based updating signals for guideline topic areas involving multiple recommendations. Further fine-tuning is recommended.
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Affiliation(s)
- Käthe Goossen
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz and Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital Du¨sseldorf, Heinrich-Heine-University, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Monika Becker
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | | | - Sascha Flohé
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Städtisches Klinikum Solingen, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
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12
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Yao X, Xia J, Jin Y, Shen Q, Wang Q, Zhu Y, McNair S, Sussman J, Wang Z, Florez ID, Zeng XT, Brouwers M. Methodological approaches for developing, reporting, and assessing evidence-based clinical practice guidelines: A systematic survey. J Clin Epidemiol 2022; 146:77-85. [PMID: 35271968 DOI: 10.1016/j.jclinepi.2022.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To produce a mapping and feature summary of approaches and tools available for the CPG community to develop, report, or assess four types of CPGs: (1) Standard original (or de novo) CPG, (2) Rapid original CPG, (3) Adapted/adopted CPGs, and (4) Updated CPGs. STUDY DESIGN The systematic literature search was conducted using Embase and PubMed, covering the period from January 2010 to October 13 2020. Two websites that collect and recommend approaches/tools to develop, report, or assess CPGs were also searched: Guidelines International Network and Equator Network. We screened the search results to include methodological papers that aimed to develop specific approaches/tools to develop, report, or assess any of the aforementioned four CPG types. RESULTS Among 10,581 citations, 46 papers reporting 46 approaches/tools were included. Of these 46 approaches/tools, 33 were about CPG development, seven were for CPG reporting, and six for CPG assessment. Among the 33 development approaches/tools, 26 did not state usability or validity information; but nine from 13 reporting or assessment approaches/tools did. CONCLUSIONS This study provides a mapping and feature summary of the current available approaches/tools, which serves to improve users' understanding to pave the way for informed choice and application.
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Affiliation(s)
- Xiaomei Yao
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Center for Clinical Practice Guideline Conduction and Evaluation, Children's Hospital of Fudan University, Shanghai, China
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, The University of Nottingham Ningbo, Ningbo, Zhejiang, China; School of Medicine, The University of Nottingham, United Kingdom
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Quan Shen
- School of Health Science, Wuhan University, Wuhan, Hubei, China
| | - Qi Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sheila McNair
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Zhiwen Wang
- School of Nursing, Health Science Centre for Evidence-Based Nursing, Peking University School of Nursing, Beijing, China
| | - Ivan D Florez
- Department of Pediatrics, University of Antioquia, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada;.
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canad
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13
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Song Y, Ballesteros M, Li J, Martínez García L, Niño de Guzmán E, Vernooij RWM, Akl EA, Cluzeau F, Alonso-Coello P. Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews. BMJ Open 2021; 11:e053587. [PMID: 34857574 PMCID: PMC8640632 DOI: 10.1136/bmjopen-2021-053587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks. DESIGN A qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants' views and experiences about adaptation process. SETTING Nine guideline development organisations from seven countries. PARTICIPANTS Guideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees' list. RESULTS We conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process. CONCLUSIONS Adaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.
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Affiliation(s)
- Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jing Li
- Research Institute (VHIR), Universitat Autònoma de Barcelona, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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14
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Wiercioch W, Nieuwlaat R, Zhang Y, Alonso-Coello P, Dahm P, Iorio A, Manja V, Mustafa RA, Neumann I, Ortel TL, Rochwerg B, Santesso N, Vesely SK, Akl EA, Schünemann HJ. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol 2021; 143:91-104. [PMID: 34843861 DOI: 10.1016/j.jclinepi.2021.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/06/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health guideline development requires sequential prioritization of the guideline topic, questions, and health outcomes. In this paper we report on new approaches for prioritizing questions and outcomes in guidelines. METHODS Ten guideline panels on venous thromboembolism rated potential guideline questions on a 9-point scale according to their overall importance and 6 criteria: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. We randomized panelists to rate one potential question with and without the 6 criteria. Panelists rated importance of outcomes, defined with health outcome descriptors (HODs), using a 9-point scale, and health utility of outcomes on a visual analogue scale. RESULTS Of 469 potential questions identified, 72.5% were rated as important but not of high priority, and 25.4% as high priority. Each criterion was significantly associated with the overall importance rating. The overall importance rating means were 5.96 (SD 2.38) and 6.53 (SD 2.45) (P = 0.25) for those randomized to rate questions with and without the criteria, respectively. The mean importance rating for 121 outcomes was 6.01 (SD 1.25), with 35.5% rated as critical for decision-making. Panelists provided health utility ratings for 127 outcomes, with a minimum mean rating of 0.12 (SD 0.10) and maximum of 0.91 (SD 0.15). CONCLUSION Our structured process provided information to help explain perspectives of question importance, to facilitate panels' outcome prioritization, and to facilitate decision-making in guideline development.
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Affiliation(s)
- Wojtek Wiercioch
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Zhang
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Philipp Dahm
- Minneapolis VAMC, Urology Section and University of Minnesota Department of Urology, Minneapolis, Minnesota
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Veena Manja
- Department of Surgery, University of California Davis, California, USA; Department of Medicine, Veterans Affairs Northern California Health Care System, Mather, California
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, North Carolina
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Nancy Santesso
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Internal Medicine, American University of Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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15
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Hill K, English C, Campbell BCV, McDonald S, Pattuwage L, Bates P, Lassig C. Feasibility of national living guideline methods: the Australian Stroke Guidelines. J Clin Epidemiol 2021; 142:184-193. [PMID: 34785347 DOI: 10.1016/j.jclinepi.2021.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Maintaining clinical guideline currency has been one challenge to traditional guideline development. This paper describes the methods used to maintain a large national guideline for stroke management. STUDY DESIGN AND SETTING The Australian Stroke Clinical Guidelines are developed to meet Australian National Health and Medical Research Council (NHMRC) standards. Monthly surveillance is conducted for new systematic reviews and randomised controlled studies. Included studies undergo data extraction followed by preparation of updated evidence-to-decision frameworks which are used to inform updates, or development of new recommendations. Small writing groups made up of clinical experts and those with lived experience review and agree on changes, which are finally reviewed by a multidisciplinary Guidelines Steering Group. Draft changes are developed and published using the online MAGICapp platform, with dissemination and promotion via traditional methods as well as social media. RESULTS Each month approximately 350 abstracts are considered, covering 96 clinical topics and taking on average 16 hours to review. There have been four major guideline updates covering 34 new and updated recommendations. CONCLUSION It is feasible to use 'living' methods to maintain the Australian Clinical Guidelines for Stroke Management. Further work is now needed to understand the impact of living guidelines.
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Affiliation(s)
- Kelvin Hill
- Stroke Services, Stroke Foundation, Melbourne, Australia.
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Peta Bates
- Stroke Services, Stroke Foundation, Melbourne, Australia
| | - Chris Lassig
- Stroke Services, Stroke Foundation, Melbourne, Australia
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- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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16
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Sanabria AJ, Alonso-Coello P, McFarlane E, Niño de Guzman E, Roqué M, Martínez García L. The UpPriority tool supported prioritization processes for updating clinical guideline questions. J Clin Epidemiol 2021; 139:149-159. [PMID: 34363971 DOI: 10.1016/j.jclinepi.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aim to 1) use the UpPriority tool to identify which clinical questions (CQs) within the clinical guidelines (CGs) need to be prioritized for updating and 2) assess the implementation of the tool in a real-world set of CGs. STUDY DESIGN AND SETTING We systematically assessed CQs from a sample of CGs developed in the Spanish National Health System CG program. We applied the UpPriority tool to each CG using a step-by-step process that included: 1) establishment of the UpPriority Implementation Working Group, 2) mapping of the original CG questions and recommendations, 3) development of a survey to prioritize CQs, 4) assessment of CQ's priority according to six items, 5) calculation and ranking of priority scores, 6) decision of prioritized CQs for updating, and 7) development of the priority report. We assessed the tool implementation process (appraisers' experience when using the tool) and the inter-observer reliability of the tool, and we provided suggestions for improvement. RESULTS We included four CGs with a total of 107 CQs on the following topics: chronic heart failure (10 CQs), inherited retinal dystrophies (39 CQs), menopause (20 CQs), and open-angle glaucoma (38 CQs). We included a total of 30 participants, most of them clinicians that were members of the original CG development groups. CQs were classified in three groups: 1) high priority (CQs prioritized for updating [16/107; 15.0%]), 2) medium priority (CQs that could be prioritized for updating [47/107; 43.9%]), and low priority (CQs that were not prioritized for updating [44/107; 41.1%]). The mean time each appraiser needed to assess the CQs with the tool was 3.8 hours (range 0.5 to 10). Agreement among the appraisers varied among the CGs. Appraisers considered that the tool was useful. We suggest some areas for consideration when using the tool including: 1) identification of key appraisers, 2) customization of training materials, 3) establishment of priority thresholds, and 4) provision of methodological support. CONCLUSION The UpPriority is a useful tool to identify which CQs within a CG need to be prioritized for update in a real-world scenario. Recruitment and training of topic experts are the main challenges when using the tool.
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Affiliation(s)
- Andrea Juliana Sanabria
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Martínez García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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