Developing clinical guidelines
Clinicians and public health practitioners cannot be expected to keep up to date with the vast amount of published research about their areas of work. Guidelines have become an important tool for summarising the implications of research and translating them into clear recommendations for ‘best practice’. They are usually developed and endorsed by national or international medical professional organisations (e.g. Royal Colleges) or health policy bodies (e.g. National Institute for Health and Care Excellence, NICE; guidelines for the NHS in England).
Guidelines should be developed using systematic reviews of the current research evidence, especially of effectiveness and cost-effectiveness. It is important that healthcare professionals, patients and carers are involved in developing guidelines and that there is a clear process for development (Figure 14a). The guideline needs an initial scoping, to identify the areas for which it should provide recommendations, such as interventions, diagnosis and prognosis. Patient experience and service delivery may also be important areas for review. The review questions should then be formulated using a framework such as PICO (Figure 14b) and explicit search strategies used to identify the relevant literature. Clear inclusion and exclusion criteria then need to be applied and the included studies critically appraised and combined if possible or necessary (Chapters 8–13 cover critical appraisal of the major study designs).
Then, in consultation with clinicians and other stakeholders, the research findings are turned into practical recommendations; for example, what types of patients will benefit from which treatments or tests, and the care and referral pathways and monitoring regimes that should ideally be followed. Recommendations should be graded according to the quality and strength of evidence supporting them (Figure 14c). GRADE (Grading of Recommendations Assessment, Development and Evaluation; www.nice.org