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6 - Development of guidelines - the process

Validity of clinical guidelines has been related to three principal factors in guideline development, namely the composition of the guideline development panel and its processes, the identification and synthesis of evidence, and the method of guideline construction (Eccles et al, 1996).

There were several stages in the development of these guidelines:

  • Identification of the topic
  • Constitution of the group responsible for developing the guidelines
  • The process of developing the guidelines
  • The presentation of the guidelines

The first stage in the development is the identification of a topic or subject. Thomson et al (1995) outlined key questions on the choice of topic which will be addressed in the context of the development of these guidelines.

In deciding the composition of the development group, several factors need to be considered. Thomson et al (1995) noted that the group should have skills in the relevant topic area, including specialist experience, to ensure the guidelines produced have professional credibility. The group may also need skills in conducting a literature review and in collecting and analysing data. Finally, the group needs a leader with the organisational and communication skills to take them through the development of the guidelines and on to implementation and review.

Again, Thomson et al (1995) provides a list of questions which create a useful framework upon which to make decisions on the composition of the development group, and go on to suggest that the internal workings of the group should be addressed. When the nature of the task is clearly defined, it is relatively easy to assess the requirements of the task in terms of a proposed time-scale. Although the group had clearly defined the need for a survey to determine current practice and for an extensive review of the literature to provide evidence for practice, it was difficult to ascertain just what was required in the guideline documentation. This was compounded by the fact that we were starting ‘from scratch’ and, until fairly late in the process, had no structure provided within which to work.

Inevitably, as all members of the group are involved in full-time demanding occupations, it has been difficult to devote time to the project and have regular meetings. All of this has created a situation whereby it was impossible to determine a specific programme to which the group could adhere. In retrospect, and for the assistance of future development groups, it is essential that, at the outset, the development group not only has clearly defined the topic/ subject of the guidelines but also has a clear indication as to what to include in the guideline documentation. Without this, there is a tendency to feel that the group is working in a vacuum with no clear idea as to how to focus its efforts. As increasing numbers of guidelines are published and become available for scrutiny, many of these problems will be resolved.

Finally, in the developmental stage, Thomson et al (1995) posed more key questions. These involved not only the actual process of identifying the evidence, but also consideration of the end users of the document. As there is a very wide range of potential users of these guidelines, we decided to provide a detailed reference document for physiotherapists and other professionals involved in the immediate management of soft tissue injuries, and to provide summary documents/leaflets which would be specifically targeted at other end users.

The decisions regarding the final presentation of the guidelines need to address several issues including both the nature of the documentation, the visual impact of the summary documents, and the most effective medium. Guidance will be sought on these matters, particularly with respect to the summary documentation, as the potential distribution of these is great.

Detailed consideration of the questions posed by Thomson et al (1995) can be seen in Appendix A.

— Phil @ 9:51 pm, June 27, 2006


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