Clinical
practice guidelines are recommendations for clinicians about the care
of patients with specific conditions. They should be based upon the
best available research evidence and practice experience.
(Source: UpToDate)
The Institute of Medicine (IOM 2011) defined
clinical practice
guidelines as "statements that include
recommendations
intended to optimize patient care that are informed by a systematic
review of evidence and an assessment of the benefits and harms of
alternative care options."
Based on this definition, guidelines have two parts: (Source: UpToDate)
1. The foundation is to perform a systematic search of existing relevant guidelines, research evidence, and systematic reviews bearing on a clinical question, focused on the strength of the evidence on which clinical decision-making for that condition is based.
2. A set of recommendations, involving both the evidence and value
judgments regarding benefits and harms of alternative care options,
addressing how patients with that condition should be managed,
everything else being equal.
Criteria for trustworthy clinical practice guidelines
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Comments
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1. Transparency
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Guidelines should include an explicit description of process and funding.
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2. Conflict of interest
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Conflicts of interest for the guidelines development group should be managed by reporting, exclusion, and divestments.
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3. Members of the guidelines development group
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The group should be multidisciplinary and balanced.
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4. Review of the literature
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The guideline should be based on systematic reviews of the literature.
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5. Rating strength of evidence and recommendations
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Each recommendation should be accompanied by the
underlying reasoning, potential benefits and harms, the evidence and its
quality, the contribution of values and experience, rating of the
level of confidence in the evidence and the strength of the
recommendation, and differences of opinion regarding recommendations.
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6. Presentation of recommendations
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The guideline should state precisely the recommended
actions, when they should be performed, and how they could be
measured for evaluation of compliance.
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7. External review
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The guidelines should be reviewed by the full spectrum
of relevant stakeholders. The general public should have an
opportunity to review the guidelines before they are final.
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8. Updating
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Guidelines should state date of publication and
evidence review and be updated when new, clinically-important evidence
is available.
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Based on data from the consensus report: Clinical Practice
Guidelines We Can Trust. Institute of Medicine of The National
Academies. Report available at: http://nationalacademies.org/hmd/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx.
Finding Guidelines