In Guidelines We Cannot Trust

The Evolution and Future of ACC/AHA Clinical Practice Guidelines: A 30-Year Journey

“…The perception that all RWI imply COI is not inherently accurate. 7,8 There is no evidence to confirm or deny that RWI lead to a bias in writing recommendations, and the quantitative impact of RWI is unknown. Bias may also exist without RWI, and individuals with RWI often have the greatest expertise in the subject.…”

“…Across CPGs, the proportion of LOE C recommendations has prompted criticism and questions about whether CPGs should define the standard of care. 8,10 Yet, when evidence is weak, conflicting, or absent, clinicians seek and need the most guidance. Moreover, it is recognized that certain LOE C recommendations that represent common sense and conventional wisdom are unlikely to be studied.…”

Improving the quality of clinical practice guidelines for clinicians and patients

“…We suggest that, in line with leading guideline development groups (for example, the UK National Institute for Clinical Excellence [NICE]), the routine involvement of information scientists, nonspecialists, and patient groups will improve the overall quality of CPGs. 10 Furthermore, compliance with the standards issued by the IOM with regard to conflicts of interest through publication of all potential conflicts, and limiting the number of participants with potential conflicts, will improve trustworthiness of these important documents. 7 Developing and writing CPGs is a substantial undertaking and we hope that these studies assessing both the quality of evidence in CPGs in liver disease and the quality of those CPGs will act as a stimulus to further improvements that will positively impact patient care.…”

Moving forward by moving back: Re-assessing guidelines for cancer distress screening

“…However, many clinical guidelines are not based on evidence [1]. Instead, preference-based value judgments sometimes outweigh evidence in guideline-making [2], with the risk of this highest when guideline panels are comprised almost entirely of clinical specialty group members. Such panels make more non-evidence-based recommendations than multi-disciplinary panels [3], including recommendations for care provided by members of the specialty group [2].…”

“…Bultz and Carlson [6] faulted our systematic review of screening for psychological distress in cancer [7] because "it contravenes recommendations to screen broadly, which are based on prevalence studies demonstrating that patients experience distress in all of the physical, psychosocial and practical domains, with a real interplay among domains" (p. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. They referred to distress screening guidelines published by the National Comprehensive Cancer Care Network (NCCN) [8].…”