Recommendations & Guidelines Flashcards
Types of treatment recommendations
Decision analysis tree
Clinical guidelines
Steps to produce a treatment guideline
Define the decision
Specify outcomes
Use available evidence to specify link between options and outcomes
Incorporate value judgements to decide on optimal course of action
Consider local circumstances such as resource availability and modify appropriately
What is decision analysis?
Provision of a formal structure to process of decision making
How is decision analysis represented?
Flowchart or tree where on the left side is the decision to be analysed
What are the branches in decision analysis tree?
Branches are the options
Where are clinical outcomes in decision analysis tree?
On the right
Describe structure of decision chart
Squares on the left are decision nodes
Circles on right are chance nodes
What needs to be done once decision analysis tree is made?
Generate quantitative estimates of likelihood or probability of events.
Then, utility value is placed on each outcome from 0 (death) - 1 (full health)
Finally, total value of each decision is calculated
How is total value of each decision calculated in decision analysis?
Cross product of utility and probability with summing of individual outcomes
Who generates practice guidelines?
Panel of stakeholders e.g. NICE
Why do guidelines based on same evidence base vary in recommendation?
Guidance is also value based and based on local availability of resources
Important step in generating guidelines?
Having a systematically reviewed bade of evidence on which recommendations can be built
What statement must be present in guidelines?
Explicit statement of values
What questions need to be asked to see if guidelines are valid?
Did all relevant patient groups, management options and outcomes get considered?
Is there a proper systematic review?
Is there an appropriate specification of values and preferences associated with outcomes?
Do the authors indicate the strength of the recommendations?
Questions to ask to determine usefulness of guidelines
Who developed them?
How were they disseminated?
How were they implemented?
