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Abstract
Background: Guidelines developed according to international standards, provide transparency in the development of the evidence-informed recommendations that result. Even in guidelines of high caliber such as those issued by the World Health Organization's Global TB Programme (WHO-GTB), additional actionable information convolute the clarity of recommendations when these guideline statements are erroneously published outside of standardized methods, and/or are mistakenly classified. This paper proposes a conceptual framework for the identification and management of guideline statements; informal recommendations, good practice and implementation statements.
Objectives: The prime objective of this work is to highlight the existence of informal recommendations ubiquitous in WHO-GTB guidelines and related publications, and to propose a framework for the identification and subsequent classification of informal recommendations, implementation considerations and good practice statements. The secondary objective of this work is to prompt the appropriate development of informal recommendations to be presented as they inherently are; a WHO-GTB recommendation.
Methods: An iterative consensus approach was taken to devise a conceptual framework for the identification and management of informal recommendations and other guideline statements. Eleven experts in health research and guideline development were invited to participate. The conceptual framework was supported by examples classified in duplicate. Five randomly selected PICO questions (Population, Intervention/Exposure, Comparison, Outcome) from five different WHO-GTB guidelines were selected to guide the application and refinement of the conceptual framework. Identification, extraction, and classification were done in duplicate and subsequent results were verified by participants.
Results: Guideline statements (informal recommendations, good practice and implementation statements) are actionable statements that differ in terms of the PICO elements they share with the formal recommendation they accompany, their link to evidence, and their eligibility for formal development. All three statements are found to be pervasive among WHO-GTB publications.
Conclusions: WHO-GTB guidelines contain recommendations that are not always sufficient to answer the PICO question from which they arose. Additional guideline statements; informal recommendations, good practice, and implementation statements, provide additional actionable guidance. These statements should be systematically identified, and appropriately managed in a guidelines’ development and final presentation.
Patient or healthcare consumer involvement: This work has been conducted in collaboration with stakeholders involved in policy work in both public and clinical health.
Objectives: The prime objective of this work is to highlight the existence of informal recommendations ubiquitous in WHO-GTB guidelines and related publications, and to propose a framework for the identification and subsequent classification of informal recommendations, implementation considerations and good practice statements. The secondary objective of this work is to prompt the appropriate development of informal recommendations to be presented as they inherently are; a WHO-GTB recommendation.
Methods: An iterative consensus approach was taken to devise a conceptual framework for the identification and management of informal recommendations and other guideline statements. Eleven experts in health research and guideline development were invited to participate. The conceptual framework was supported by examples classified in duplicate. Five randomly selected PICO questions (Population, Intervention/Exposure, Comparison, Outcome) from five different WHO-GTB guidelines were selected to guide the application and refinement of the conceptual framework. Identification, extraction, and classification were done in duplicate and subsequent results were verified by participants.
Results: Guideline statements (informal recommendations, good practice and implementation statements) are actionable statements that differ in terms of the PICO elements they share with the formal recommendation they accompany, their link to evidence, and their eligibility for formal development. All three statements are found to be pervasive among WHO-GTB publications.
Conclusions: WHO-GTB guidelines contain recommendations that are not always sufficient to answer the PICO question from which they arose. Additional guideline statements; informal recommendations, good practice, and implementation statements, provide additional actionable guidance. These statements should be systematically identified, and appropriately managed in a guidelines’ development and final presentation.
Patient or healthcare consumer involvement: This work has been conducted in collaboration with stakeholders involved in policy work in both public and clinical health.