Article type
Abstract
Background:Clinical care protocols (CCPs) are detailed instructions about how to do a specific task. CCPs, similar to clinical practice guidelines (CPGs), are intended to standardise clinical attention; however, CCPs statements are mandatory in the local context where they were developed. In cancer care, the need to create CCPs is increasing, especially in low-income countries where the evidence must be adjusted to the local circumstances.
Objectives:To create a handbook about how to develop evidence-based CCPs, using a systematic approach.
Methods:Once the scope and objectives were defined, we made a systematic search in electronic databases, CPGs developers’ websites, and others. As inclusion criteria, the document must have established the steps required to make CCPs and must have defined CCPs as “detailed instructions about how to do a specific health care activity”. Two team members made the selection, extraction, and quality assessment independently, and the discrepancies were resolved through discussion. In case that there was a CCP development step without high-quality evidence, the step details were obtained through CPGs methods adaptation; and, in absence of evidence, the team made a systematic review followed by a RAND/UCLA consensus.
Results:The search detected 6425 records. After the selection process, 15 documents were included; 53% were reported in Spanish and 40% were handbooks. The global quality was intermediate. The CCPs making steps were similar to CPGs; nonetheless, the CCPs manuals made more emphasis on instructions about how to generate clinical management flowcharts and how to report them than CPGs manuals. Although the CCPs are CPGs implementation tools, there was a lack of evidence about how to do CCPs implementation. The quality report was poor in topics related to how to elaborate the CCPs questions, and how to include the evidence. Our handbook included 15 steps and is currently being validated.
Conclusions: CCPs has similar steps with CPGs making. Even though there is scarce information about how to include the evidence and how to do their local implementation, CCPs seems to be a useful tool to standardise cancer care.
Objectives:To create a handbook about how to develop evidence-based CCPs, using a systematic approach.
Methods:Once the scope and objectives were defined, we made a systematic search in electronic databases, CPGs developers’ websites, and others. As inclusion criteria, the document must have established the steps required to make CCPs and must have defined CCPs as “detailed instructions about how to do a specific health care activity”. Two team members made the selection, extraction, and quality assessment independently, and the discrepancies were resolved through discussion. In case that there was a CCP development step without high-quality evidence, the step details were obtained through CPGs methods adaptation; and, in absence of evidence, the team made a systematic review followed by a RAND/UCLA consensus.
Results:The search detected 6425 records. After the selection process, 15 documents were included; 53% were reported in Spanish and 40% were handbooks. The global quality was intermediate. The CCPs making steps were similar to CPGs; nonetheless, the CCPs manuals made more emphasis on instructions about how to generate clinical management flowcharts and how to report them than CPGs manuals. Although the CCPs are CPGs implementation tools, there was a lack of evidence about how to do CCPs implementation. The quality report was poor in topics related to how to elaborate the CCPs questions, and how to include the evidence. Our handbook included 15 steps and is currently being validated.
Conclusions: CCPs has similar steps with CPGs making. Even though there is scarce information about how to include the evidence and how to do their local implementation, CCPs seems to be a useful tool to standardise cancer care.