Approval processes in evidence-based clinical practice guidelines sponsored by medical specialty societies.

Jeffrey Sonis,Olivia M Chen

doi:10.1371/journal.pone.0229004

Abstract

ObjectiveTo determine the approval processes for evidence-based Clinical Practice Guidelines sponsored by medical specialty societies in the United States.Study design and settingCross-sectional analysis of published Clinical Practice Guidelines and Guideline procedure manuals, sponsored by the 43 members of the Council of Medical Specialty Societies in the United States. Approval processes were measured by written evidence in the specialty society’s guideline procedure manual or published guidelines, through May 2017.ResultsAmong the 36 (of 43) specialty societies that published evidence-based Clinical Practice Guidelines, 27 (75%) required approval by a committee representing the society as a whole. None specified the criteria used for approval decisions. Six specialty societies (17%) required approval but included procedures to maintain some editorial independence for the guideline development group, such as approval by a guideline committee not an executive committee or approval dependent on fidelity to established guideline methodology, not content. One society required Board review, but not approval. The approval process was not reported by 2 (6%) of the specialty societies.ConclusionsMost medical specialty societies in the U.S. require approval of guidelines by a board that represents the society as whole. Since medical specialty societies have loyalties to the patients they serve and to their physician members, and because the interests of those two groups may differ, such an approval process introduces a potential conflict of interest into the guideline development process.

Highlights

IntroductionThere is widespread agreement that conflict of interest has the potential to impair the ability of guideline development panels to draw valid conclusions and make sound recommendations that are worthy of patient, physician and policy-maker trust [1,2]
Among the 36 specialty societies that published evidence-based Clinical Practice Guidelines, 27 (75%) required approval by a committee representing the society as a whole
Since medical specialty societies have loyalties to the patients they serve and to their physician members, and because the interests of those two groups may differ, such an approval process introduces a potential conflict of interest into the guideline development process

Summary

Introduction

There is widespread agreement that conflict of interest has the potential to impair the ability of guideline development panels to draw valid conclusions and make sound recommendations that are worthy of patient, physician and policy-maker trust [1,2]. There has been little attention directed to the potential for the policies and procedures of a guideline development panel to introduce conflict of interest. This issue is salient in practice guidelines that are sponsored by medical specialty societies. Medical specialty societies produce most clinical practice guidelines (CPGs) used in the United States [5]. Those societies possess advantages for the creation of CPGs, including access to clinicians with relevant expertise, members likely to be supportive of guideline development, and funding to support guideline development [5,6]. Since the financial and professional interests of clinicians may conflict with the health needs of patients in certain situations, this dual mission raises the concern for conflict of interest when specialty societies create evidence-based CPGs [5]

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Discussion

Conclusion