Comparison of development methodologies used by guideline groups

Publications

A poster of the research was presented at the Guidelines International Network conference in Toronto, Canada in August 2007.

Summary

There are calls for guideline organisations to pool their resources and develop guidelines collaboratively rather than individually. To achieve this, the methodological principles used by groups would need to be common and result in the systematic identification and synthesis of the best available scientific evidence. Denise Campbell and co-authors compared the development process of 3 nephrology guideline groups with the process used by a number of major guideline organisations. The latest NHMRC guidance on essential steps in guideline development was used as a methodology benchmark. A sample guideline from each organisation was also assessed for quality, using the AGREE criteria.

The results showed that the quality of guidelines produced by non-nephrology organisations is generally higher than those produced by nephrology groups. There are wide variations in the process used by different groups and some of these are due to the difference in resources and skills available to a group. Few organisations assess the impact of socioeconomic position in relation to the condition of interest, determine benefits/harms, compare costs/benefits of interventions, or determine cost-effectiveness and feasibility of recommendations as a routine part of guideline development. Most organisation’s guidelines yield low ‘Applicability’ scores, which means Work Groups are not considering the likely organisational, behavioural and cost implications of applying a guideline. There is a need for guideline organisations to expand their methodological process so that more thoughtful and practical guideline recommendations are developed.