Earlier this month, the U.S. GRADE Network welcomed 51 participants to the Twelfth GRADE Guideline Workshop in sunny Phoenix, Arizona. Two participants, Giulia Lane and Hayley Dunnack, were awarded a scholarship from the Evidence Foundation that covered their workshop registration fee. As the two latest additions in a line of over 40 Foundation scholars since 2014, Lane and Dunnack presented to their fellow participants about their projects related to improving the use of evidence-based decision-making in healthcare.
Hayley Dunnack, left, and Giulia Lane, right, were the recipients of the Evidence Foundation scholarship for the spring 2020 GRADE workshop held in Phoenix, AZ
Hayley Dunnack: Opportunities and Challenges in Guidelines for Nursing Practice
Hayley Dunnack, BSN, CMS-RN, OCN is a PhD candidate at the University of Connecticut School of Nursing. Dunnack presented on her work with the Oncology Nursing Society (ONS) to develop guidelines on symptom management for patients with cancer. Currently, ONS has several projects underway to develop guidelines on symptom management based on systematic reviews of the evidence and using GRADE guideline methodology. A current challenge in the ONS’ guideline development relates to the development of guidelines on topics for which randomized studies are sparse or difficult to conduct, such as the management of hypersensitivity reactions or the use of vascular access devices. Dunnack’s project aims to examine the use of non-randomized and “real-world” evidence to inform the development of rigorous guidelines based on systematic reviews and using the GRADE process.
“I had an incredible experience at the GRADE Guideline Development Workshop,” said Dunnack. “From the didactic material to the small group sessions, there was so much to learn. The ability to network with other professionals and hear their viewpoints added immensely to the experience."
Dunnack and Lane pose with Dr. Shahnaz Sultan of the U.S. GRADE Network
Giulia Lane: Shared Decision-Making in Urology Guidelines
Dr. Giulia Lane is a urology fellow at the University of Michigan. Lane’s project examines the current uptake and opportunities for improvement in the use of shared decision-making aids in the field of urology. Although shared decision-making aids are a critical step of assessing patients’ values and preferences, Lane explained, they are not commonly used in the field of urology. While almost everyone completes the initial step of informing patients about treatment options, exploring individual preferences is less frequent, and of the 29 American Urological Association (AUA) guidelines reviewed by Dr. Lane, only 12 mention shared decision-making at all. Of those guidelines that mentioned shared decision-making by name, only seven (58%) further described the process. Clinicians in urology, Dr. Lane concluded, are not provided support or encouragement to use shared decision-making in their practice. However, this appears to be changing: shared decision-making was mentioned in 2019 guidelines nearly eight times as often as those published in 2010.
In contrast to what is commonly believed, shared decision-making does not take more time once clinicians are trained. Clinicians should consider providing ready-made online modules to patients to review ahead of their visit, further reducing the time required to improve patient engagement and understanding of their treatment options. Dr. Lane’s work provides a baseline assessment of the use of shared decision-making in urology and will help inform the direction of future research in this area.
“I felt that the best part of the GRADE workshop was the small-group setting with intimate access to experts in the field,” said Dr. Lane. “The networking opportunities were exceptional and I met several people with whom I plan to collaborate. The people I met at the GRADE workshop and the transfer of ideas were the most important take away point for me.”
If interested in applying for a scholarship to future GRADE workshops, more details can be found here: https://evidencefoundation.org/scholarships.html. Please note the deadline for applications to our next workshop in Chicago, Illinois will be July 31, 2020.