Challenge of implementing clinical practice guidelines. Getting ESMO’s guidelines even closer to the bedside: introducing the ESMO Practising Oncologists’ checklists and knowledge and practice questions

Abstract

In an ever more rapidly evolving and complex medical landscape, guidelines are paramount for even the most experienced practitioner to ensure delivery of optimal and safe care for patients. There is no doubt that modern clinical practice guidelines (CPG) can make life a lot easier for practising physicians, and a lot safer for their patients, as they often provide a stepwise algorithm which will walk physicians through the important steps of decision-making during the diagnostic and therapeutic management of their patients. Medical guidelines have already been established thousands of years ago, as witness papyrus finds dated back from the times of the Pharaohs of Egypt. Some may have been empiric. Most were based on authority, beliefs, rituals or tradition.1 The modern era of CPGs begins in 1992, with the Institute of Medicine’s definition: Clinical Practice Guidelines are systematically developed statements to assist practitioner’s decision about appropriate health care for specific clinical circumstances.2 They are supposed to bridge the gap between research and current practice, and thus to reduce inappropriate variability in practice.3 Modern clinical guidelines should be based on the highest quality of evidence according to current data, leading to a general consensus in state-of-the-art diagnosis and therapy of diseases, and a standardised approach to patient care. This is highly appreciated in situations of multiple treatment options, in situation of sparse evidence, or of uncertainty.4 Guidelines may be related to diseases or procedures. They are mainly developed for diseases with high prevalence or frequently used medical procedures, high associated costs and current variations in practice. They are of particular interest in diseases in which diagnostic or treatment decisions may have a high impact on mortality, morbidity, quality of life and care-related costs.5 The production of guidelines involves a technical and a social process: best evidence has …