From “getting things right” to “getting things right now”: Developing COVID‐19 guidance under time pressure and knowledge uncertainty

Abstract

Background At the start of the COVID‐19 pandemic, guidance was needed more than ever to direct frontline healthcare and national containment strategies. Rigorous guidance based on robust research was compromised by the emergence of the pandemic and the urgency of need for guidance. Rather than aiming to “get guidance right”, guidance developers needed to “get guidance right now”. Aim To examine how guidance developers have responded to the need for credible guidance at the start of the COVID‐19 pandemic. Methods An exploratory mixed‐methods study was conducted among guidance developers. A web‐based survey and follow‐up interviews were used to examine the most pertinent challenges in developing COVID‐19 guidance, strategies used to address these, and perspectives on the implications of the COVID‐19 pandemic on future guidance development. Results The survey was completed by 46 guidance developers. Survey findings showed that conventional methods of guidance development were largely unsuited for COVID‐19 guidance, with 80% ( n = 37) of respondents resorting to other methods. From the survey and five follow‐up interviews, two themes were identified to bolster the credibility of guidance in a setting of extreme uncertainty: (1) strengthening end‐user involvement and (2) conjoining evidence review and recommendation formulation. 70% ( n = 32) of survey respondents foresaw possible changes in future guidance production, most notably shortening development time, by reconsidering how to balance between rigour and speed for different types of questions. Conclusion “Getting guidance right” and “getting guidance right now” are not opposites, rather uncertainties are always part of guidance development and require guidance developers to balance scientific robustness with usability, acceptability, adequacy and contingency. This crisis points to the need to acknowledge uncertainties of scientific evidence more explicitly and points to mechanisms to live with such uncertainty, thus extending guidance development methods and processes more widely.

Mediating scarcity in pandemic times: an ethnographic study on the prevention and control of SARS-CoV-2 infections during the emergence of the corona crisis in the Netherlands

“…As much knowledge lacked in the beginning, the guidelines could not always be based on existing empirical evidence on this specific virus, and often got based on the tacit knowledge of the infection prevention experts and their network (cf. [ 18 ]). Understanding the new virus research was a collective effort that caused many discussions within the UNIP and with the interdisciplinary team meetings of the OMT-IP.…”

“…Guidelines, in the literature often depicted as inflexible and based on ‘work-as-imagined’ [ 24 ], to the contrary in our case-study proved to be essential in bringing together the different worlds of healthcare professionals, faciliatory staff, crisis managers and people working on infection prevention. Moreover, guidelines proved to be not static, but very dynamic, as their almost continuous rewriting allowed for the inclusion and representation of new insights and valuations, responding to the developments of the pandemic ([ 18 ] cf.). Future research on resilience should take this dynamic role of guidelines and their relation to accountability into account.…”

Evidence‐basing for quality improvement; bringing clinical practice guidelines closer to their promise of improving care practices

“…6 adequacy, and contingency. [40][41][42] In spite of this study's limitations, we feel that our study's contribution to the current state of guideline development remains relevant. In the subsequent paragraphs, we outline how this study contributes to the question of how the efficacy of CPGs as tools for quality improvement can be strengthened.…”

“…Guideline developers particularly struggled with this problem during the Covid‐19 pandemic, where guidance had to be developed under extreme time pressure and knowledge uncertainty. A mixed‐methods study 40 has highlighted the pertinence of developing methods to produce credible guidance in the absence of ‘high‐quality’ evidence. It is expected that the Covid‐19 pandemic may act as a catalyst for addressing a problem that has existed long before the pandemic: the scientific uncertainties that are always part of guideline development and require developers to balance scientific robustness with feasibility, acceptability, adequacy, and contingency 40–42 .…”

“…A mixed‐methods study 40 has highlighted the pertinence of developing methods to produce credible guidance in the absence of ‘high‐quality’ evidence. It is expected that the Covid‐19 pandemic may act as a catalyst for addressing a problem that has existed long before the pandemic: the scientific uncertainties that are always part of guideline development and require developers to balance scientific robustness with feasibility, acceptability, adequacy, and contingency 40–42 . In spite of this study's limitations, we feel that our study's contribution to the current state of guideline development remains relevant.…”