Guideline development

Question 1

Accessing information pathway

Answer 1

1. Clinical guidelines
2. Evidence summaries
3. Systematic reviews
4. Primary data
5. Information specialist aid

Question 2

What are evidence summaries

Answer 2

They summarise the existing evidence and identify gaps. Include clinical evidence summaries

Question 3

What are clinical guidelines

Answer 3

Comprehensive literature reviews that cover whole disease management pathways. their recommendations are based on evidence and expertise. They engage stakeholders. E.g. NICE

Question 4

The process of developing guidelines

Answer 4

1. Recommendation
2. Understand how guideline development moved from evidence to recommendation
3. Assess strength for each clinical outcome
4. Review the search strategies used
5. Determine what focused clinical question they sought to address

Question 5

How do you assess strength of the evidence in guidelines

Answer 5

Using GRADE- a standard, transparent tool used which provides a framework for assessing strength of evidence in guidelines. It has 5 domains which are downgraded with lessening certainty

Question 6

What are the 5 domains of GRADE

Answer 6

1. Risk of bias (hierarchy of evidence, critical appraisal)
2. Imprecision (width of CIs)
3. Inconsistency (overlapping CIs/ I2 in SR)
4. Indirectness (applicability)
5. Publication bias (effect of missing evidence)

Question 7

Considerations when making guidelines

Answer 7

Strength/ confidence of evidence (GRADE), cost (money, resources, skills), patient preferences, difference in desired effect and adverse effects

Question 8

How is strength of guidelines conveyed?

Answer 8

Through the wording

Question 9

What is used to appraise quality of guidelines?

Answer 9

AGREE-II tool (domains 1, 3 and 5 similar to CASP, rest address stakeholder engagement and clarity)

Question 10

How are guidelines useful

Answer 10

Facilitate shared decision making and aid in quality assurance e.g. audits

Question 11

What is shared decision making

Answer 11

A process in which the clinician and patient work together to select tests, management plans, support packages etc based on evidence and informed patient preferences

Question 12

Why do shared decision making

Answer 12

Legal requirement (consent)
Professional obligation (GMC)
Evidence-based (increase adherence, reduce health inequalities, medicalisation, admission etc)
Moral imperative

Question 13

Consequences of no SDM

Answer 13

Preference misdiagnosis (assuming patient preference and therefore not giving them the option they actually want, had they been informed)
Poor adherence
Harm
Opportunity costs

Question 14

Practice of SDM

Answer 14

Listening and acknowledging that different patients have different values, therefore will make different decisions
1. Build a relationship
2. Choice talk
3. Option talk
4. Deliberation
5. Decision talk
6. Review

Question 15

Who brings expertise to decision making

Answer 15

Clinician and patient
Patient expertise on living with a condition, social circumstances, values, attitudes to risk and preferences