FORM: An Australian method for formulating and grading recommendations in evidence-based clinical guidelines

Susan Hillier,Tracy Merlin,Janet Salisbury,Rebecca Tooher,Karen Grimmer-Somers,Adele Weston,Philippa Middleton

doi:10.1186/1471-2288-11-23

Abstract

BackgroundClinical practice guidelines are an important element of evidence-based practice. Considering an often complicated body of evidence can be problematic for guideline developers, who in the past may have resorted to using levels of evidence of individual studies as a quasi-indicator for the strength of a recommendation. This paper reports on the production and trial of a methodology and associated processes to assist Australian guideline developers in considering a body of evidence and grading the resulting guideline recommendations.MethodsIn recognition of the complexities of clinical guidelines and the multiple factors that influence choice in health care, a working group of experienced guideline consultants was formed under the auspices of the Australian National Health and Medical Research Council (NHMRC) to produce and pilot a framework to formulate and grade guideline recommendations. Consultation with national and international experts and extensive piloting informed the process.ResultsThe FORM framework consists of five components (evidence base, consistency, clinical impact, generalisability and applicability) which are used by guideline developers to structure their decisions on how to convey the strength of a recommendation through wording and grading via a considered judgement form. In parallel (but separate from the grading process) guideline developers are asked to consider implementation implications for each recommendation.ConclusionsThe framework has now been widely adopted by Australian guideline developers who find it to be a logical and intuitive way to formulate and grade recommendations in clinical practice guidelines.

Highlights

Clinical practice guidelines are an important element of evidence-based practice
This paper reports on the production and trial of a methodology and associated processes to assist Australian guideline developers in considering a body of evidence and grading the resulting guideline recommendations
The new FORM framework was loosely based on the Scottish Intercollegiate Guidelines Network (SIGN) considered judgement form [8]

Summary

Introduction

Clinical practice guidelines are an important element of evidence-based practice. Considering an often complicated body of evidence can be problematic for guideline developers, who in the past may have resorted to using levels of evidence of individual studies as a quasi-indicator for the strength of a recommendation. Best practice in health care should be guided by the results of research on the safety and effectiveness of different courses of clinical action This evidence needs to be assembled, justified and presented in the form of health advice for multiple stakeholders including health professionals, decision makers and consumers of health care. As early as 1999, the NHMRC commissioned and published ‘Guidelines for Guideline Development’ [3], anticipating the need for a comprehensive set of resources to help guideline developers produce high quality guidelines. This was followed by a more detailed series of handbooks on different aspects of finding and reviewing clinical research [4]. These standards (such as rigorous evidence-based methods, multidisciplinary panels and public consultation processes) have resulted in NHMRC approved guidelines being of higher quality than those developed outside NHMRC processes [5]

Methods

Results

Conclusion