What are some advantages of writing guidelines? (4)
- They reduce unnecessary variation
- Improve quality of patient care by encouraging beneficial treatments
- Empowers patients and public policy
- Can save lives
What are some disadvantages of writing guidelines? (6)
- 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
What are some economic evaluations that may be involved in writing guidelines? (5)
- 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
What are some guideline recommendations? (6)
Language should be clear, simple and persuasive
- Reduces cognitive load
- Increases understanding
- Convincing arguments
NICE guidelines:
Start with a verb
One action per recommendation
When are guidelines updated? (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
How are recommendations rated? (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
How is quality of evidence rated? (4)
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
What are the different stages in writing guidelines? (11)
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
What are some uncertainties of writing guidelines? (5)
- 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
