Quiz 6 Flashcards
Briefly (approx. 300 words) outline the pros and cons of clinical practice guidelines.
Pros =
High-quality guidelines differ from systematic reviews as they provide recommendations for care based on a combination of scientific research evidence, clinical expertise and patient values. They often provide an overview of the prevention, diagnosis and management of a condition or the than systematic reviews, which tend to focus on a single clinical question. Potential benefits of guidelines include achieving better health outcomes, improving decisions about health care, and saving time.
Cons =
However, guideline development is not easy and involves large amounts of time, money, expertise and effort. The development process can be lengthy and sometimes the evidence used in a guideline may not be the most current evidence by the time it is finally published. Many guidelines do not provide clear information about conflicts of interest within the guideline development group and how these were handled during the development process.
More: specific information on topic to answer this question is available in chapter 13 of the textbook and via the online lecture (week 10).
What are clinical practice guidelines?
a) Fixed, step-by-step protocols to follow, informed by a systematic review of the evidence and assessment of the benefits and harms of alternative care options
b) 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
c) A collection of systematic review of the evidence of the benefits and harms of alternative care options intended to optimize patient care
d) A meta-analysis of clinical evidence of the benefits and harms of alternative care options intended to optimize patient care
b) 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
More: further information is available in the first couple pages of chapter 13
A well-developed, trustworthy guideline should contain rigorously compiled information and recommended actions to guide practice. They should also:
a) Include a multidisciplinary panel of experts and key stakeholders during the development, rate the strength of the included evidence and consider subgroups and patient preferences
b) Include a multidisciplinary panel of experts and key stakeholders during the development, consider subgroups and patient preferences and provide a fixed protocol which must be followed
c) Rate the strength of the included evidence, consider subgroups and patient preferences and provide an estimate of how much a course of action will cost
d) Include a multidisciplinary panel of experts and key stakeholders during development, consider subgroups and patient preferences and provide an estimate of how much a course of action will cost
a) Include a multidisciplinary panel of experts and key stakeholders during the development, rate the strength of the included evidence and consider subgroups and patient preferences
More: review chapter 13 of the textbook for more detail on this question
Which of the following statements best differentiates a clinical guideline from a systematic review?
a) Uses an explicit and transparent process to minimise bias
b) Appraises the quality of evidence used in generation of the final publication
c) Needs to be continually revised and updated with the latest evidence
d) Takes into account research evidence, patient values and clinical expertise
d) Takes into account research evidence, patient values and clinical expertise
More: review chapter 13 of the textbook for more information
Very briefly ( pprox.. 50words), describe what the AGREE II instrument is an how it is utilized. Dot points considered to be appropriate.
The AGREE (appraisal of guidelines for research and evaluation) instrument is the most widely used and internationally accepted tool for assessing the quality of CPGs. Originally developed by international collaboration in 2003. The collaboration defined quality of guidelines as ‘the confidence that the potential biases of guideline development have been addressed adequately and that the recommendations are both internally and externally valid and are feasible fro practice’. The AGREE tool appraises guidelines based on how they score on 23 items, which are grouped into 6 major domains, followed by 2 global-rating overall assessment items. To increase reliability it is recommended that each guideline is assessed by at least 2 people.Each of the AGREE II items is rated on a 7-point scale (1 = strongly disagree to 7 = strongly agree) regarding the extent to which the guideline meets the particular item. The domains and items are:
- Scope and purpose
a. The overall objective(s) of the guideline is (are) specifically described.
b. The health question(s) covered by the guideline is (are) specifically described
c. The population (patients, public etc) to whom the guidelines is meant to apply is specifically described. - Stakeholder involvement
a. The guideline development group includes individuals from all the relevant professional groups.
b. The views and preferences of the target population have been sought
c. The target users of the guidelines are clearly defined - Rigour of development
a. Systematic methods were used to search for evidence
b. The criteria for selecting the evidence are clearly described
c. The strengths and limitations of the body of evidence are clearly described
d. The methods of formulating the recommendation are clearly described
e. The health benefits, side effects and risks have been considered in formulating the recommendations.
f. There is an explicit link between the recommendations and the supporting evidence
g. The guideline has been externally reviewed by experts prior to its publication
h. A procedure for updating the guideline is provided - Clarity of presentation
a. The recommendations are specific and unambiguous
b. The different options for management of the condition or health issue are clearly presented
c. Key recommendations are easily identifiable - Applicability
a. The guideline describes facilitators and barriers to its application
b. The guideline provides advice and/or tools on how the recommendations can be put into practice
c. The potential resource implications of applying the recommendations have been considered
d. The guideline presents monitoring and/or auditing criteria - Editorial independence
a. The views of the funding body have not influenced the content of the guideline
b. Competing interests of guideline development group members have been recorded and addressed - OVERALL GUIDELINE ASSESSMENT
a. Rate the overall quality of this guideline (scale of 1 to 7 with 1 being the lowest and 7 highest possible quality)
b. I would recommend this guideline for use (yes / yes with modifications / no
More: an excellent summary of the AGREE II instrument is included on pg 331-333 of the textbook or in the online lecture (week 10)
The use of shared decision-making in clinical practice has some challenges. Which of the following is a major barrier to the use of shared decision making?
a) Most patients do not want to take part in shared decision-making
b) Patients with severe cognitive impairment or medical emergencies
c) Most employers of health professionals prefer staff not to use shared decision-making as it greatly increases the length of consultations
d) All responses are correct
More: for more information, review chapter 14 of the textbook
b) Patients with severe cognitive impairment or medical emergencies
Pictographs can be used by health professionals to communicate statistics to patients in a manner they may find easier to understand. If you use a 1000 circle pictograph to communicate the risk (mortality) of undergoing a particular intervention and 40 circles are coloured in, what is the absolute risk?
a) The patient has a 40% risk of dying
b) The patients risk of dying is 40 in 1000
c) For every 40 people who receive treatment 1 will die
b) The patients risk of dying is 40 in 1000
More: in this case you are advising the patient that if 1000 people are treated, 40 of them will die.
Outline the shared decision making process and its ability to improve patient outcomes
Shared decision making (SDM) is a process whereby clinicians collaboratively help patients to reach evidence-informed and value-congruent medical decisions. This process is especially relevant in screening for conditions in which there is a close trade-off between harms and benefits. Shared decision-making can lead to improved patient outcomes, the primary goal of shared decision-making is simply to ensure that patients receive good care. While not easier, shared decision-making can make care better.
More: see the resources from week 11 for more details on this topic
