Article type
Abstract
Background:
The Clinical Practice Guideline (CPG) on Palliative Care within the National Health System (NHS) was one of the Program's initial guidelines. Following a decade since its publication, the Ministry of Health requested a review of its recommendations and develop an updated version. The main challenges were methodological and related to the new conceptualization of Palliative Care, extending beyond end-of-life care.
Objectives:
To describe the updating process of the the CPG on Palliative Care of the Spanish NHS Guidelines Program.
Methodology:
The updating process was divided in 2 phases. For each phase it will be described the processes and main results. Besides, other evidence synthesis products beyond guidelines developed through the process will be described.
Results:
First phase comprised the process of assessing the need for updating and prioritisation. A working group was formed, including key specialties and patients. Consultations were conducted with patient organizations and scientific societies (43 experts). The bibliographic searches of CPGs and systematic reviews performed retrieved 6 CPG and 37 systematic reviews. In this phase the updating of the clinical management in the last days of life and palliative sedation was prioritized, developed and designed in a living mode. Different versions were also produced for patients and caregivers. Considering the complexity of making recommendations on organizational models at the national level, a health technology assessment report on early palliative care was developed. In a second phase, a new reassessment and prioritisation of outstanding areas was carried out, taking into account evidence derived from 7 guidelines and 73 systematic reviews. The decision in this phase was updating of the clinical area related to communication, shared decision-making and advance care planning and it is currently under development. The need to address psychological, social, and spiritual needs was identified. The update of the clinical area on symptom management was discarded due to the need to address this within the comprenhensive management of different conditions and disease trajectories.
Conclusions:
The modular updating approach has proven effective in address the most relevant clinical areas and maintaining them in a living mode through continuous updating of scientific evidence.
The Clinical Practice Guideline (CPG) on Palliative Care within the National Health System (NHS) was one of the Program's initial guidelines. Following a decade since its publication, the Ministry of Health requested a review of its recommendations and develop an updated version. The main challenges were methodological and related to the new conceptualization of Palliative Care, extending beyond end-of-life care.
Objectives:
To describe the updating process of the the CPG on Palliative Care of the Spanish NHS Guidelines Program.
Methodology:
The updating process was divided in 2 phases. For each phase it will be described the processes and main results. Besides, other evidence synthesis products beyond guidelines developed through the process will be described.
Results:
First phase comprised the process of assessing the need for updating and prioritisation. A working group was formed, including key specialties and patients. Consultations were conducted with patient organizations and scientific societies (43 experts). The bibliographic searches of CPGs and systematic reviews performed retrieved 6 CPG and 37 systematic reviews. In this phase the updating of the clinical management in the last days of life and palliative sedation was prioritized, developed and designed in a living mode. Different versions were also produced for patients and caregivers. Considering the complexity of making recommendations on organizational models at the national level, a health technology assessment report on early palliative care was developed. In a second phase, a new reassessment and prioritisation of outstanding areas was carried out, taking into account evidence derived from 7 guidelines and 73 systematic reviews. The decision in this phase was updating of the clinical area related to communication, shared decision-making and advance care planning and it is currently under development. The need to address psychological, social, and spiritual needs was identified. The update of the clinical area on symptom management was discarded due to the need to address this within the comprenhensive management of different conditions and disease trajectories.
Conclusions:
The modular updating approach has proven effective in address the most relevant clinical areas and maintaining them in a living mode through continuous updating of scientific evidence.