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Practitioners As Experts: The Influence of Practicing Oncologists "in-the-Field" on Evidence-Based Guideline Development

From the Margaret and Charles Juravinski Cancer Centre, Hamilton Health Sciences; Cancer Care Ontario, Program in Evidence-Based Care; and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Address reprint requests to George P. Browman, MD, Tom Baker Cancer Centre, 1331-29th St NW, Calgary, Alberta, Canada T2N 4N2; e-mail: georgebr{at}cancerboard.ab.ca

PURPOSE: Panels of experts are used to develop clinical practice guidelines (CPGs) intended to be used by practitioners "in-the-field." Therefore, oncologists’ participation in CPG development is an important strategy to promote CPG adoption. The purpose of this study was to evaluate the contributions of oncologists in-the-field to evidence-based CPG development using data from Ontario’s cancer system.

METHODS: CPG development in Ontario includes surveys of oncologists’ opinions, using a structured questionnaire, about draft recommendations that were developed from rigorous systematic reviews of evidence prepared by expert panels. Two research assistants reviewed background documents to trace the changes in CPG recommendations from draft to final stage to determine the contribution of oncologists’ input to final recommendations. Changes to recommendations were categorized as either substantive (content or tone) or minor (ideas clarification or edits).

RESULTS: From 2000 to 2003, 43 CPGs were developed. There were 87 changes to draft recommendations for 31 CPGs, of which 40 changes to 19 CPGs could be attributed to survey input from practicing oncologists. Of the 40 changes, 28 (70%) were judged to be substantive.

CONCLUSION: Despite a rigorous evidence-based process for CPG development, practicing oncologists contribute substantially to the final recommendations approved by the expert panel. It is hypothesized that the responsiveness of expert panels to input from oncologists in-the-field will facilitate adoption of CPGs.

Supported by Cancer Care Ontario, Program in Evidence-Based Care, and Ontario Ministry of Health and Long Term Care.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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