Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST

Abstract

BACKGROUND Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easyto-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST).METHODS A modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring.RESULTS Twenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful. CONCLUSIONThe 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians.

When is a guideline not a guideline? The devil is in the details

“…Using The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, this multidisciplinary team evaluates emerging evidence and conducts systematic reviews in order to produce trustworthy practice recommendations. Additionally, a number of checklists have been developed that can be used to assist guideline developers, clinicians and journal editors (eg, the Reporting Items for Practice Guidelines in Healthcare,13 the Checklist for the Reporting of Updated Guidelines,14 the Guideline Trustworthiness, Relevance, and Utility Scoring Tool 1516 noting that ‘biased guidelines can cause grave harms to patients’,17 developed a brief tool to help assess the reliability of guideline recommendations.…”

Managing conflicts of interest in the development of health guidelines

“…43,45 Patient involvement in guidelines, particularly if patient partners receive funding to advocate for their condition, must also be considered. In addition to the potential future expansion of the GIN principles, journal editorial requirements and tools for evaluating guidelines [46][47][48] could both play a role in addressing these gaps. For example, one new tool obtains information directly from guideline group members on whether COIs were managed appropriately during development.…”

Participation and consultation engagement strategies have complementary roles: A case study of patient and public involvement in clinical practice guideline development

“…Numerous organizations recommend or require that guideline developers engage health consumers, patients and/or patient representatives in guideline development, including the Guidelines International Network, the United States’ Institute of Medicine (IOM, now renamed the National Academy of Medicine) and the United Kingdom's National Institute for Health and Care Excellence . Both the Appraisal of Guidelines for Research and Evaluation II instrument and the Guideline Trustworthiness, Relevance and Utility Scoring Tool assess diversity in stakeholder involvement, including the presence of patient representatives. PPI in guidelines is advocated because it leads to the development of more patient‐centred and trustworthy guidelines, recognizes patients as experts, respects citizen rights in developing health policy, and empowers and informs consumers making health‐care decisions…”