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Report: Cancer Guidelines Do Not Fully Meet IOM Standards

Authors question criteria for best quality of care (June 12)

In an age when evidence-based care is increasingly important, how trustworthy are current clinical practice guidelines?

Researchers at the University of Michigan Comprehensive Cancer Center looked at 169 clinical practice guidelines for lung, breast, prostate, and colorectal cancers and found that none of the guidelines fully met standards set in 2011 by the Institute of Medicine (IOM). Of eight criteria, the guidelines on average met fewer than three.

“None of the current guidelines we looked at met all of the standards, but some of these are really good guidelines. It begs the question: How pragmatic are the Institute of Medicine standards? In some ways, are these standards too strict?” says lead author Sandra Wong, MD, MS.

The IOM standards for clinical practice guidelines were developed to ensure that guidelines truly reflect the best quality of care. The standards cover eight criteria, including disclosing conflicts of interest, using systematic reviews of the literature, seeking external review, and updating recommendations regularly.

In the new study, published in the Journal of Clinical Oncology, researchers reviewed clinical practice guidelines that covered recommendations for screening, diagnosis, treatment, or follow-up care.

On average, the guidelines met 2.75 of eight major criteria and 8.24 of 20 sub-criteria. The most common gaps were in managing conflicts of interest and in including patients or other lay people in the process.

“The IOM was trying to define what you need to have trustworthy guidelines. But if a group does not include a forum for public comment on the guidelines, does that make the guideline less trustworthy? Is that as important as whether they incorporate a systematic review of the literature? One consideration is that perhaps all standards should not be weighted the same across the board,” Wong says.

She also suggests creating a balance between ideal standards and what is practical to ensure that guidelines can be put in place in a timely manner. Some guidelines already take more than a year to create.

Source: University of Michigan; June 12, 2013.

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