In Part I, we discussed the importance of reporting crucial details about the development process of a guideline and the various tools and checklists used to assess the quality of guidelines through what is reported.
In this post, we’ll provide a list of items that guidelines commonly neglect to report but which can easily and instantly improve the chances of a positive quality appraisal of a guideline. Remember: items that don’t have to do with the recommendations directly can always be described in detail elsewhere, such as in a supplemental document or a web site. Just make sure all materials are referenced in the guideline text so that its users – and those who may be assessing the guideline for research purposes – can easily find the relevant information.
1. The target audience. Be explicit about who the guideline is and isn’t targeted toward. Rather than “healthcare professionals,” specifically list specialties and/or settings when appropriate (e,g., neurologists, primary care providers in low-income communities).
2. The clinical questions. All good answers must begin with a well-formulated question, but it is surprisingly common for guidelines to leave out an explicit description of the key questions driving the guideline. Why was this guideline created? What questions are the recommendations addressing? Simply listing all questions in PICO (Population, Intervention, Comparison, Outcome) format at the beginning of the text and even as subheaders throughout the document will effectively guide readers through the text and provide helpful context for the appropriate application of recommendations.
3. The patient voice. The use of patient/consumer representation in the planning of a guideline and in drafting the resulting recommendations appears on many assessment tools and standard sets. If patients or consumers are involved in the development of a guideline at any part of the process, make sure to describe how and when – including whether educational strategies to increase their effective participation where used. Plans for dissemination of recommendations to the public beyond healthcare providers also apply here.
4. The external review and public comment process. How were external reviewers selected? Were their identities kept confidential from the guideline authors? Did the guideline panel keep a formal documentation of all reviewers’ comments and respond to each one specifically? Lastly, was the guideline available for public comment, and how long was it available? The addition of these fine details is relatively easy but can drastically improve the assessment of a guideline in this domain.
5. Implementation considerations. A perfect guideline is worth nothing if it isn’t followed. What are some potential barriers for appropriate implementation of the guideline of which its users should be aware? Have any tools been developed to improve the chances of successful implementation? How might resource availability affect implementation, and how should implementation be monitored?
6. Conflicts of interest. This crucial aspect of guideline development goes further than simply listing interest disclosures of the authors. If any potential conflicts exist, describe how they were managed throughout the process. If the guideline has been funded by external sources, it’s important to note this and to describe the terms of the funding.
7. Plans for update. Along with indicating the date of the relevant review of evidence, describe any plans and procedures for surveillance of the literature and updating of the guidelines. In addition, provide an expiration date for the current guideline.
Whether being read by a provider with the intention of implementing its recommendations or by a researcher assessing its quality, a guideline is only as good as how well it is written. Including as much information as possible, whether in the text of the guideline itself or in a referenced external source, will improve the chances of a fair appraisal of a guideline’s quality – and, more importantly, its successful implementation.