The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation.

Abstract

PURPOSE To develop a conceptual tool for the systematic development of cancer treatment practice guidelines. MATERIALS AND METHODS The guidelines development tool, the Practice Guidelines Development Cycle, was derived from observing an evidence-based practice guidelines initiative at a comprehensive cancer center in Ontario, Canada, and from a literature review that uncovered barriers to guidelines development and implementation. Based on the literature findings and direct observations of how clinicians struggled with evidence-based guidelines development, we evolved a framework to incorporate clinical and administrative factors (eg, costs) into evidence-based guidelines. Use of the Practice Guidelines Development Cycle is illustrated with a clinical example (the use of adjuvant systemic therapy in good-risk, node-negative premenopausal breast cancer patients). RESULTS The result is the Practice Guidelines Development Cycle, which consists of eight sequential steps, from topic selection to policy formulation. Independent validation of guidelines is included. The cycle products are the evidence-based recommendation, the practice guideline, and the practice policy. The main features of the cycle are emphasis on scientific evidence, acknowledgment of the roles of clinical experience and nonclinical (administrative) factors through consensus, and explicit separation of clinical and cost considerations in guidelines development. Twenty guidelines are currently in development. CONCLUSION Attention to the barriers of guidelines development and the sociocultural nature of clinical practice, and respect for clinical experience, can lead to improved strategies for guidelines development.

The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

“…As the British Columbia guidelines impose certain assumptions about the structure of the stratification scheme, recursive partitioning was also used to assess the factors associated with adjuvant systemic therapy in each provincial cohort (Breiman et al, 1994). This is an assumption-free statistical approach that partitions the data into groups to ascertain the relationships between independent variables and the dependent variable, in this case the treatment received.…”

Temozolomide for the Treatment of Metastatic Melanoma: A Systematic Review

“…This systematic review was developed by Cancer Care Ontario's Program in Evidence-based Care, using the methods of the Practice Guidelines Development Cycle [2], and will serve as the basis for a clinical practice guideline on the use of temozolomide in the treatment of metastatic melanoma to be posted on the Cancer Care Ontario website (http:// www.cancercare.on.ca).…”

SOR: project methodology

“…The methodological approach combines systematic review with expert judgement, rather than methods based entirely on either scientific data or the opinion of experts (Mulrow, 1987;Woolf, 1992;Fervers et al, 1995;Browman et al, 1995). It thus provides qualitative systematic reviews as compared to quantitative systematic reviews or meta-analyses.…”