Clinical Practice Guidelines

Clinical practice guidelines or CPGs are “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.” They attempt to distill a large body of medical knowledge into a convenient, user-friendly format by making recommendations about how the evidence can be applied in actual practice while taking into consideration context-specific issues such as cost and patient values and preferences. Ultimately, the goal of CPGs is to improve the quality and safety of health care by reducing inappropriate variations in practice; describing appropriate care based on the best available scientific evidence and a broad

Public disclosure of the source of funding for the CPG and potential past and present COIs of panel members;
2. Exclude conflicted individuals from the guideline panel (eg. those with financial ties to industry or to the funder; authors of studies being considered). In instances when there are no content experts without COIs, limit the number of conflicted panel members to a distinct minority.
3. Include methodologists (experts on research methodology, critical appraisal, and interpretation of evidence) who are not content experts in the guideline panel. Content experts are more likely to accept the results of a study if these are consistent with current beliefs or preconceptions even if there are questions regarding its quality.3 Independent methodologists will be in a better position to identify and address any methodologic issues that are raised.
4. Exclude panel members with conflicts from deliberations, drafting, and voting on the recommendations.

Guidelines should describe in detail how conflicts of interest were addressed during the guideline development process. This will allow users of the CPG to evaluate if COIs were managed adequately. For example, the American College of Chest Physicians published its approach to managing conflicts of interest in guideline development in

Were there systematic reviews of evidence?

To ensure the validity of the recommendations in a CPG, it is important that there is a clear link between each recommendation and the evidence on which they are based. This can be achieved through systematic reviews of evidence that utilize a highly structured method of searching, evaluating, and summarizing relevant research studies.4

Using systematic reviews to guide decisions about recommendations ensure that these recommendations are based on the best available evidence at the time they were made. Sometimes, however, evidence may be lacking for particular outcomes of interest. In these instances, the lack of information, which results in some degree of uncertainty, should be acknowledged as this may have a bearing on what the guideline panel ultimately recommends. For example, in its guidelines for breast cancer screening, the U.S. Preventive Services Task Force does not make recommendations for mammography in women 75 years and older because there is insufficient evidence on the benefits and harms of screening for women in this age