Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

Abstract Introduction Assessing the process used to synthesise the evidence in clinical practice guidelines (CPGs) enables users to determine the trustworthiness of the recommendations. We aimed to assess whether systematic methods were used when synthesizing the evidence for CPGs; and whether reviews or ‘overviews of reviews’ were cited in support of recommendations.Methods and analysis We followed a study protocol. CPGs published in 2017 and 2018 were retrieved from TRIP and Epistemonikos. We randomly sorted and sequentially screened the CPGs to select the first 50 that met our inclusion criteria. Our primary outcomes were the numbers and proportions of recommendations that were based on reviews and ‘overviews‘, and CPGs using either a systematic or non-systematic process to gather, assess, and synthesise evidence. We also looked for evidence that critical appraisal was conducted. We also performed a chi-square test of independence to examine the relationship between variables. Results Of the 50 guidelines, 34% did an exceptional job in systematically synthesising the evidence to inform recommendations. These guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. 66% of CPGs reported non-systematic methods to develop their recommendations. This percentage is likely an underestimation because we excluded some CPGs when selecting studies. Overall, 90% of CPGs cited reviews to inform recommendations, and one fifth cited a Cochrane systematic review. Of the 29 CPGs that included reviews, 21% critically appraised the review. 60% of CPGs assessed the quality of primary studies. Conclusions We used novel methodology to evaluate recommendations in a random sample of CPGs, and found that 62% did not use a systematic process to gather, appraise, and synthesise the evidence. Significant improvement is needed in the conduct and reporting of CPG methods. Guideline developers should use systematic methods endorsed by reputable evidence synthesis organisations.

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Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

PLoS ONE ◽

10.1371/journal.pone.0250356 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250356

Author(s):

Carole Lunny ◽

Cynthia Ramasubbu ◽

Lorri Puil ◽

Tracy Liu ◽

Savannah Gerrish ◽

...

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Assessment Tool ◽

Evidence Synthesis ◽

Validity And Reliability ◽

Eligibility Criteria ◽

Comprehensive Search

Introduction Assessing the process used to synthesize the evidence in clinical practice guidelines enables users to determine the trustworthiness of the recommendations. Clinicians are increasingly dependent on guidelines to keep up with vast quantities of medical literature, and guidelines are followed to avoid malpractice suits. We aimed to assess whether systematic methods were used when synthesizing the evidence for guidelines; and to determine the type of review cited in support of recommendations. Methods Guidelines published in 2017 and 2018 were retrieved from the TRIP and Epistemonikos databases. We randomly sorted and sequentially screened clinical guidelines on all topics to select the first 50 that met our inclusion criteria. Our primary outcomes were the number of guidelines using either a systematic or non-systematic process to gather, assess, and synthesise evidence; and the numbers of recommendations within guidelines based on different types of evidence synthesis (systematic or non-systematic reviews). If a review was cited, we looked for evidence that it was critically appraised, and recorded which quality assessment tool was used. Finally, we examined the relation between the use of the GRADE approach, systematic review process, and type of funder. Results Of the 50 guidelines, 17 (34%) systematically synthesised the evidence to inform recommendations. These 17 guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. Of the 29/50 guidelines that included reviews, 6 (21%) assessed the risk of bias of the review. The quality of primary studies was reported in 30/50 (60%) guidelines. Conclusions High quality, systematic review products provide the best available evidence to inform guideline recommendations. Using non-systematic methods compromises the validity and reliability of the evidence used to inform guideline recommendations, leading to potentially misleading and untrustworthy results.

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Methodology for Evidence Synthesis and Development of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.s1-s26 ◽

2021 ◽

Vol S1;24 (1;S1) ◽

pp. S1-S26

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Systematic Reviews ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Observational Studies ◽

Evidence Synthesis ◽

Evidence Based ◽

Interventional Techniques

BACKGROUND: The re-engineered definition of clinical guidelines in 2011 from the IOM (Institute of Medicine) states, “clinical practice guidelines are statements that include recommendations intended to optimize patient care that is informed by a systematic review of evidence and an assessment of the benefit and harms of alternative care options.” The revised definition distinguishes between the term “clinical practice guideline” and other forms of clinical guidance derived from widely disparate development processes, such as consensus statements, expert advice, and appropriate use criteria. OBJECTIVE: To assess the literature and develop methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. METHODS: A systematic review of the literature including methodology of guideline development encompassing GRADE approach for guidance on evidence synthesis with recommendations. RESULTS: Some of the many factors described in 2011 continue as of 2020 and impede the development of clinical practice guidelines. These impediments include biases due to a variety of conflicts and confluence of interest, inappropriate and poor methodological quality, poor writing and ambiguous presentation, projecting a view that these are not applicable to individual patients or too restrictive with the elimination of clinician autonomy, and overzealous and inappropriate recommendations, either positive, negative, or non-committal. Thus, ideally, a knowledgeable, multidisciplinary panel of experts with true lack of bias and confluence of interest must develop guidelines based on a systematic review of the existing evidence. This manuscript describes evidence synthesis from observational studies, various types of randomized controlled trials (RCTs), and, finally, methodological and reporting quality of systematic reviews. The manuscript also describes various methods utilized in the assessment of the quality of observational studies, diagnostic accuracy studies, RCTs, and systematic reviews. LIMITATIONS: Paucity of publications with appropriate evidence synthesis methodology in reference to interventional techniques. CONCLUSION: This review described comprehensive evidence synthesis derived from systematic reviews, including methodologic quality and bias measurement. The manuscript described various methods utilized in the assessment of the quality of the systematic reviews, RCTs, diagnostic accuracy studies, and observational studies. KEY WORDS: Evidence-based medicine (EBM), interventional pain management, evidence synthesis, methodological quality assessment, conflict of interest, confluence of interest, comparative effectiveness research (CER), clinical practice guidelines, systematic reviews, meta-analysis

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Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study (Preprint)

10.2196/preprints.11846 ◽

2018 ◽

Author(s):

Azizeh Khaled Sowan ◽

Meghan Leibas ◽

Albert Tarriela ◽

Charles Reed

Keyword(s):

Intensive Care ◽

Quality Of Care ◽

Clinical Practice ◽

Nursing Care ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Care Plan ◽

System Use ◽

Nurses Perceptions

BACKGROUND The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. OBJECTIVE This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. METHODS A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. RESULTS Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system (P=.10 to P=.25). CONCLUSIONS Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.

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Quality of clinical practice guidelines for the management of hypertension in six Southeast Asian countries

Clinical and Experimental Hypertension ◽

10.1080/10641963.2021.1925683 ◽

2021 ◽

pp. 1-9

Author(s):

Chia Siang Kow ◽

Syed Shahzad Hasan ◽

Pei Se Wong ◽

Rohit Kumar Verma

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Southeast Asian ◽

Asian Countries ◽

Southeast Asian Countries

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Assessment of the quality, content and perceived utility of local maternity guidelines in hospitals in England implementing the saving babies’ lives care bundle to reduce stillbirth

BMJ Open Quality ◽

10.1136/bmjoq-2019-000756 ◽

2020 ◽

Vol 9 (2) ◽

pp. e000756

Author(s):

Yu Zhen Lau ◽

Kate Widdows ◽

Stephen A Roberts ◽

Sheher Khizar ◽

Gillian L Stephen ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Stakeholder Involvement ◽

Care Bundle ◽

Intrapartum Care ◽

National Guidelines ◽

Department Of Health ◽

The Uk

IntroductionThe UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.MethodsSeventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.ResultsUnit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.ConclusionTo successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.

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Clinical Practice Guidelines andHelicobacter pyloriInfection in Children

Canadian Journal of Gastroenterology ◽

10.1155/1999/939476 ◽

1999 ◽

Vol 13 (7) ◽

pp. 560-562 ◽

Cited By ~ 1

Author(s):

Colin Macarthur ◽

Liisa Jaakkimainen

Keyword(s):

Health Care ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Guideline Development ◽

Guideline Implementation ◽

Key Steps ◽

Evidence Based Guidelines ◽

Care Costs

The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

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