Clinical Practice Guidelines

Services and resources to support guideline writing
FirstFrame 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. Learn how to gather the evidence in this brief tutorial
Presented by Carolyn Van Leeuwarden, Instruction and Liaison Librarian, HNE Health Libraries. Recorded February 2022.
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. (UpToDate 2022).

The Institute of Medicine defines 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." (IOM  2011).

Based on this definition, guidelines have two parts:
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. (UpToDate 2022).

Criteria for trustworthy clinical practice guidelines


Standard

Comments

1. Transparency

Guidelines should include an explicit description of process and funding.

2. Conflict of interest

Conflicts of interest for the guidelines development group should be managed by reporting, exclusion, and divestments.

3. Members of the guidelines development group

The group should be multidisciplinary and balanced.

4. Review of the literature

The guideline should be based on systematic reviews of the literature.

5. Rating strength of evidence and recommendations

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.

6. Presentation of recommendations

The guideline should state precisely the recommended actions, when they should be performed, and how they could be measured for evaluation of compliance.

7. External review

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.

8. Updating

Guidelines should state date of publication and evidence review and be updated when new, clinically-important evidence is available.

Based on data from the consensus report: Clinical Practice Guidelines We Can Trust. Institute of Medicine of The National Academies.

Finding Guidelines

The most trustworthy guidelines can be recognized by adherence to best practices for guideline development identified by the Institute of Medicine (IOM).

These guidelines are required to meet specific criteria requiring a systematic review and an assessment of benefits and harms. The primary goal of any clinical practice guideline is to provide clear transparent guidance to practicing physicians regarding patient management based on the best available evidence.
 Sources of clinical practice guidelines
CIAP logo Guidelines in McMaster Plus (Systematic guidelines)
NHMRC logo National Health and Medical Research Council. Australian clinical practice guidelines
NICE logo NICE. Guidance, NICE advice and quality standards
CIAP logo

RACGP. Clinical guidelines

UpToDate logo Royal Children's Hospital Melbourne. Clinical practice guidelines
UpToDate logo TripPro. Clinical practice guidelines
HNELHD logo HNELHD. Developing a HNE Health policy, procedure or guideline
HNELHD logo HNELHD. Policies, procedures and guidelines (PPG) management