Browman George P, Makarski Julie, Robinson Paula, Brouwers Melissa
Margaret and Charles Juravinski Cancer Center, Hamilton Health Sciences, Ontario, Canada.
J Clin Oncol. 2005 Jan 1;23(1):113-9. doi: 10.1200/JCO.2005.06.179.
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.
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).
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.
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.
专家小组负责制定临床实践指南（CPG），供“一线”从业者使用。因此，肿瘤学家参与CPG制定是促进CPG采用的一项重要策略。本研究的目的是利用安大略省癌症系统的数据，评估一线肿瘤学家对基于证据的CPG制定的贡献。
安大略省的CPG制定包括使用结构化问卷对肿瘤学家关于从专家小组对证据进行的严格系统评价中得出的建议草案的意见进行调查。两名研究助理审查背景文件，以追踪CPG建议从草案到最终阶段的变化，从而确定肿瘤学家的意见对最终建议的贡献。建议的变化分为实质性（内容或语气）或轻微（观点澄清或编辑）两类。
2000年至2003年，共制定了43项CPG。31项CPG的建议草案有87处变化，其中19项CPG的40处变化可归因于执业肿瘤学家的调查意见。在这40处变化中，28处（70%）被判定为实质性变化。
尽管CPG制定过程基于严格的证据，但执业肿瘤学家对专家小组批准的最终建议做出了重大贡献。据推测，专家小组对一线肿瘤学家意见的响应性将促进CPG的采用。
