Writing guidelines

Question 1

What are some advantages of writing guidelines? (4)

Answer 1

• They reduce unnecessary variation
• Improve quality of patient care by encouraging beneficial treatments
• Empowers patients and public policy
• Can save lives

Question 2

What are some disadvantages of writing guidelines? (6)

Answer 2

• They do not consider comorbidities
• They are mostly applicable to an ‘average’ patient
• Fear of litigation
• Lack of patient involvement
• Conflicting advice from different clinical guidelines
• Lag time in updating the clinical guidelines

Question 3

What are some economic evaluations that may be involved in writing guidelines? (5)

Answer 3

• Quality of life and healthcare cost on life gained
• Cost varies over time, exclusivity and geographical region
• Cost utility analysis- a single measure such as QALY
• Balancing effectiveness and freeing up resources with cost
• Incremental cost effectiveness ratio (ICER)- less than £20k per QALY is cost effective

Question 4

What are some guideline recommendations? (6)

Answer 4

Language should be clear, simple and persuasive

• Reduces cognitive load
• Increases understanding
• Convincing arguments

NICE guidelines:
Start with a verb
One action per recommendation

Question 5

When are guidelines updated? (5)

Answer 5

When there is a significant change in:

• Evidence of existing benefits/ harms
• Resources available for healthcare
• Clinically important outcomes
• New interventions
• Value placed on outcomes

Question 6

How are recommendations rated? (6)

Answer 6

COR:
Class I- recommended
Class II- a- should be considered, b- may be considered
Class III- not recommended

LOE
A- multiple studies and analyses
B- Single randomised trial/ many non randomised
C- Opinion of experts/ small studies

Question 7

How is quality of evidence rated? (4)

Answer 7

GRADE:
High- further research unlikely to change recommendation
Moderate- future research can change strength of recommendation
Low- further research is likely to change recommendation
Very low- any estimate of effect is uncertain and further research will probably change the recommendation

Question 8

What are the different stages in writing guidelines? (11)

Answer 8

Usually done by Guideline development group

1) Scope of guidance
- Populations/ settings
- Identifying key issues
- Economic evaluation

2) Evidence review
- Define review questions
- Online databases
- Eligible studies
- Trial registers

3) Rating of evidence

Question 9

What are some uncertainties of writing guidelines? (5)

Answer 9

• Quality of evidence
• Balance between safety and efficacy
• Performances in different groups
• Resource allocation
• Even a straightforward disease such as hypertension has a guideline over 40 pages