- Early release
- 1 September 2013
The forum participants were asked to spend time in small groups to discuss the issues raised during the day and make suggestions, particularly in relation to the following six key questions.
It is important to make it very clear from the start of any guideline project that there are processes and tools that can be used to assess the quality of evidence and risk of bias. There should be training for the health workforce (providers and researchers) to help them understand how to use these tools. Ethics committees and guideline development team members could be trained on ethical and scientific assessment of study design.
A range of changes to the way clinical trials are designed and funded are supported, including:
Guideline development teams need to be seen to be independent and have a Chair without any conflicts of interest and, if required, an expert Co-chair. To ensure that guideline teams adopt processes for interpreting evidence in a way that addresses the risk of bias, the following strategies are proposed:
It is important that people involved in guideline development and the assessment of therapeutic evidence have appropriate skills and expertise in their work. However, there should be a range or balance and diversity of interests represented – they should not be dominated by one group or one approach.
Before inviting people to join a guideline team, find out about each prospective team member's interests.
Discuss the need for transparency of interests with the people invited to be part of a guideline or project team. Advise them that their declarations of interests will be shared with other members of the group and published with the guideline.
There should be full public disclosure of all pecuniary and non-pecuniary interests of the group members so that the interests can be actively managed by the Chair.
Provide the Chairs of guideline development groups with training on the range of strategies available to manage conflicts of interest.
There needs to be a clear policy describing the steps that can be adopted to manage conflicts, and the process for making decisions should be agreed in advance. These processes should be reported in guidelines or other publications.
Processes for managing conflicts should include:
Clinicians and consumers want to rely on the credibility of the agency providing advice. There needs to be clear information explaining that disclosure of interests is not ‘naming and blaming’, but is a credible professional and ethical operating process.
End users want to be able to assess the significance of the interest, to know that a process of managing the interest has been followed, and to be given advice about how to interpret the impact of the interest.
It would be useful to research what effect disclosures have on the perception of reliability of guidelines.
Should guideline developers such as Therapeutic Guidelines and other guideline development agencies include being agents for change? Should they take on an ‘activist’ role, promoting change in practice and addressing public health outcomes in guidelines?
Some of the activities guideline developers could consider include: