PHRM3031 - guidelines and communicating risk

Question 1

guidelines - what? why?
defintion
purpose of the NHMRC guidelines

Answer 1

• sets of non-mandatory rules, principles or recommendations for procedures or practices in a particular field
• NHMRC guidelines promote health, prevent harm, encourage best practice and reduce unnecessary waste developed by multidisciplinary committees or panels who follow a rigorous evidence-based approach
• NHMRC have guidelines for: public health, environmental health, health and research ethics, clinical practice

Question 2

Guidelines - Advantages

Answer 2

• recommendations for care based on scientific evidence, clinical expertise and patient values
• overview of prevention, diagnosis and management of a condition
• help to reduce variation in practice
• can save time, improve decision and produce better health outcomes

Question 3

Guidelines - Disadvantages

Answer 3

• long process (time, money, expertise, effort) - can be dated
• need to provide clear information about conflicts of interest and how managed
• guidelines are not fixed protocols - need sensible clinical judgement
• often in single condition - do not cover multimorbidities
• some clinical evidence is of low quality

Question 4

how therapeutic guidelines are produced

what
who it is for
based on

Answer 4

• independent not-for-profit organisation
• Aim: promote the quality use of medicines –> writing, publication and sale of TG
• mostly for prescribers (esp GPs) to provide clear, practical, succinct and up-tp-date therapeutic information, for the management of patients with specific conditions
• based on the latest international literature, interpreted by some of Australia’s most eminent and respected experts and input from GPs etc
• ->information is independent and unbiased and is a distillation of current evidence and opinion

Question 5

2016 NHMRC standard for guidelines

9 standards

Answer 5

1. relevant and useful for decision making
2. transparent
3. guideline development group
4. identify and manage conflicts of interest
5. focused on health and related outcomes
6. evidence informed
7. make actionable recommendations
8. up-to-date
9. accessible

Question 6

how valid and reliable are the conclusions? grade definition/features

Answer 6

grade is best practice - features:

• risk of bias
• precision of the effect estimate
• consistency of the individual study results
• how directly the evidence answers the question of interest
• risk of publication or reporting biases

Question 7

how to use the guidelines in practice?

6

Answer 7

1. ask the question (PICO) –> relevant guideline
2. applicable to patient (clinical scenario)
3. setting - health system (resources, etc)
4. consider the associated values (vs. patient) NB not a mandate for practice –> interpret for your situation
5. additional tools may be useful (IT, updates)
6. consider medico-legal issues

Question 8

why we need to communicate effectively

Answer 8

• informed consent
• patients involved in decision making
• building trust
• maximising effectiveness of treatment
• -> patient centred-care

Question 9

why we communicate about evidence

5

Answer 9

• understand patient’s experiences and expectations
• build a partnership
• discuss evidence (+uncertainties)
• present recommendations
• confirm understanding and agreement

Question 10

how we communicate about evidence

Answer 10

• verbal
• written
• videos/audios
• internet
• decision aids

Question 11

how to present information

Answer 11

• be open about uncertainty of benefits and risks
• give info on positive and negative outcomes (avoid bias)
• use same denominator both +ve and -ve outcomes
• use natural frequencies rather than probabilities
• if use relative risk values then also use absolute risk values
• need baseline risk in context of intervention
• avoid using qualitative descriptors without clear explanation -perception can vary a lot
• use multiple formats
• less is more -avoid giving too much information