Journal of Clinical Oncology, Vol 13, 502-512, Copyright © 1995 by American Society of Clinical Oncology
The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation
GP Browman, MN Levine, EA Mohide, RS Hayward, KI Pritchard, A Gafni and A Laupacis
Ontario Cancer Treatment and Research Foundation, Canada.
PURPOSE: To develop a conceptual tool for the systematic development of
cancer treatment practice guidelines. MATERIALS AND METHODS: The guidelines
development tool, the Practice Guidelines Development Cycle, was derived
from observing an evidence-based practice guidelines initiative at a
comprehensive cancer center in Ontario, Canada, and from a literature
review that uncovered barriers to guidelines development and
implementation. Based on the literature findings and direct observations of
how clinicians struggled with evidence-based guidelines development, we
evolved a framework to incorporate clinical and administrative factors (eg,
costs) into evidence-based guidelines. Use of the Practice Guidelines
Development Cycle is illustrated with a clinical example (the use of
adjuvant systemic therapy in good-risk, node-negative premenopausal breast
cancer patients). RESULTS: The result is the Practice Guidelines
Development Cycle, which consists of eight sequential steps, from topic
selection to policy formulation. Independent validation of guidelines is
included. The cycle products are the evidence-based recommendation, the
practice guideline, and the practice policy. The main features of the cycle
are emphasis on scientific evidence, acknowledgment of the roles of
clinical experience and nonclinical (administrative) factors through
consensus, and explicit separation of clinical and cost considerations in
guidelines development. Twenty guidelines are currently in development.
CONCLUSION: Attention to the barriers of guidelines development and the
sociocultural nature of clinical practice, and respect for clinical
experience, can lead to improved strategies for guidelines development.
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