Critical Appraisal Of Clinical Practice Guidelines Essay

Critical Appraisal Of Clinical Practice Guidelines

Guide to the Critical Appraisal of Clinical Practice Guidelines (CPG)

Student Name:

Faculty name:

Reference of CPG:

1. WHAT QUESTION ARE YOU TRYING TO ANSWER?

Patients

Intervention

Comparison

Outcome(s)

2. ARE THE RESULTS OF THE GUIDELINES VALID?

Questions that need asking

What is this, and where do I find this information?

Details from Assigned CPG

Include page number as applicable

Is the group, committee, or organization that developed the guidelines clearly identified?

Yes / No

Can’t tell

This information is usually located either right at the front of the guidelines, or in the back of the document in an appendix. For some guideline groups, this information is located on their website at point of download of the guideline itself.

Did authors declare conflicts of interest among all parties involved in guideline preparation and consensus?

Yes / No

Can’t tell

Conflict of interest is essential to locate within a clinical practice guideline (CPG) to ensure validity. Sometimes the writers of CPGs have financial or expert relationships with pharmaceutical companies or are extensively involved in other research studies that might negatively bias the development of objective CPGs. Conflict of interest should ideally be stated up front within the guideline, but may also be included in a paragraph at the very back of a document.

Is there proof of a systematic literature search and strategic selection of articles for review? (Was it a SYSTEMATIC PROCESS?)

Yes / No

Can’t tell

All CPGs need to describe the literature review (and the timeline; example 2000-2009) whereby evidence was located. Specific databases where the search occurred should be cited (e.g., Medline, PubMed, Embase, Cochrane). Again, this should be noted within the first few pages of the CPG.

Have evidence ratings or indicators of value been indicated for each guideline?

Yes / No

Can’t tell

CPGs should be developed by consensus. In doing so, there should be a specific scale to rate the quality and strength of evidence and also the consensus result. This might look like “Grade 1a,” which might suggest a highly rated recommendation and a highly rated consensus among the CPG committee. This should be noted for each and every guideline within the CPG and be noted throughout the document.

To what extent has expert opinion been identified for particular guidelines – is it extensive?

Yes / No

Can’t tell

Sometimes, background research is just not available to help inform CPGs on particular topics. In these instances, guideline groups or committees sometimes choose to create a statement or guideline that is based solely on expert opinion or experience of experts. While a few statements of this nature are usually accepted within guidelines, a high percentage of statements within a CPG may be inappropriate. Further, clinicians using these guidelines must consider the risks and value of using expert opinion-based guidelines to make clinical decisions.

3. WHAT ARE THE RESULTS?

Questions that need asking

What is this, and where do I find this information?

Details from Assigned CPG

Include page number as applicable

Is there a clear message on the clinical importance and practical value for use of these guidelines?

Yes / No

Can’t tell

All CPGs must be written in practical and implementable statements. They must not be vague or generic; they are intended to be actionable and easy to understand without risk of misinterpretation.

Is there discussion of benefits, harm, risks, and cost impacts?

Yes / No

Can’t tell

High-quality CPGs provide specific information within the guidelines about patient-specific benefits, harms/risks, and also cost of implementation of the guidelines in clinical settings. This is essential to note because it informs the prospective user of the CPG of what implementation aspects might warrant further review.

Are these guidelines of recent age? Do the results include reference to currently available treatments or interventions?

Yes / No

Can’t tell

Most clinical practices note changes every 5 years or so. As such, a CPG that is older than this timeframe may not be appropriate, particularly if there is mention of older and less-used medications particular to your clinical practice setting.

4. WILL THE RESULTS HELP ME IN CARING FOR MY PATIENT?

Questions that need asking

Response

What is this?

Details from Assigned CPG

Include page number as applicable

Are the guidelines presented in a user-friendly and easy-to-follow format?

Yes / No

Can’t tell

Guidelines that are difficult to understand or hard to follow can be prone to misinterpretation. There is also greater likelihood that the CPG will not be embraced and used consistently in clinical settings if it is hard to interpret.

Do the guidelines offer next steps for practical implementation; recognition of implementation barriers?

Yes / No

Can’t tell

Most good CPGs include suggestions for next steps including a standardized documentation, standing-orders form, or audit assessment sheet, for example. This may also include a sample patient or family education pamphlet, posters for health care professionals, electronic flags for charts, or other resources. It is a good sign that some suggestions and tools are provided for implementation by guideline developers.

Is there discussion of clinical flexibility for application in multiple or diverse clinical settings?

Yes / No

Can’t tell

Remember that CPGs created exclusively for implementation in large tertiary facilities may not be directly applicable in smaller or community-based health care settings. A strong CPG should identify some general recommendations of special implementation for different settings. As an example, a CPG intended for use in hospitals may not necessarily be effective for implementation in rural clinic settings.

Overall Appraisal: In one succinct paragraph, give a narrative overall appraisal that includes a summary of the strengths and weaknesses of the guideline, as well as its use for the identified PICO question.

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Critical Appraisal Of Clinical Practice Guidelines Essay

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