Browman G P, Levine M N, Mohide E A, Hayward R S, Pritchard K I, Gafni A, Laupacis A
Ontario Cancer Treatment and Research Foundation, Canada.
J Clin Oncol. 1995 Feb;13(2):502-12. doi: 10.1200/JCO.1995.13.2.502.
To develop a conceptual tool for the systematic development of cancer treatment practice guidelines.
The guidelines development tool, the Practice Guidelines Development Cycle, was derived from observing an evidence-based practice guidelines initiative at a comprehensive cancer center in Ontario, Canada, and from a literature review that uncovered barriers to guidelines development and implementation. Based on the literature findings and direct observations of how clinicians struggled with evidence-based guidelines development, we evolved a framework to incorporate clinical and administrative factors (eg, costs) into evidence-based guidelines. Use of the Practice Guidelines Development Cycle is illustrated with a clinical example (the use of adjuvant systemic therapy in good-risk, node-negative premenopausal breast cancer patients).
The result is the Practice Guidelines Development Cycle, which consists of eight sequential steps, from topic selection to policy formulation. Independent validation of guidelines is included. The cycle products are the evidence-based recommendation, the practice guideline, and the practice policy. The main features of the cycle are emphasis on scientific evidence, acknowledgment of the roles of clinical experience and nonclinical (administrative) factors through consensus, and explicit separation of clinical and cost considerations in guidelines development. Twenty guidelines are currently in development.
Attention to the barriers of guidelines development and the sociocultural nature of clinical practice, and respect for clinical experience, can lead to improved strategies for guidelines development.
开发一种用于系统制定癌症治疗实践指南的概念工具。
指南制定工具“实践指南制定周期”源自对加拿大安大略省一家综合癌症中心基于证据的实践指南倡议的观察，以及一项揭示指南制定和实施障碍的文献综述。基于文献研究结果以及对临床医生在基于证据的指南制定过程中所面临困难的直接观察，我们构建了一个将临床和管理因素（如成本）纳入基于证据的指南的框架。通过一个临床实例（高危、淋巴结阴性的绝经前乳腺癌患者辅助全身治疗的应用）来说明“实践指南制定周期”的使用。
成果是“实践指南制定周期”，它由从主题选择到政策制定的八个连续步骤组成。包括对指南的独立验证。该周期的产物是基于证据的建议、实践指南和实践政策。该周期的主要特点是强调科学证据，通过共识认可临床经验和非临床（管理）因素的作用，并在指南制定过程中明确区分临床和成本考量。目前正在制定二十项指南。
关注指南制定的障碍和临床实践的社会文化性质，以及尊重临床经验，能够带来改进的指南制定策略。
