BMJ  2005;331:631-633 (17 September), doi:10.1136/bmj.331.7517.631

Education and debate

Developing clinical guidelines: a challenge to current methods

Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

Current methods for producing clinical guidelines are cumbersome and not always reliable. Could a more streamlined approach improve coverage and make decisions more transparent?

The first 150 words of the full text of this article appear below.

Introduction

Clinical guidelines are rarely based solely on research evidence. In most cases they also incorporate the consensus views of experts. Despite recognition of the need for rigour in developing a consensus, current approaches often lack sufficient transparency, fail to make clear what influence the level of resources in the health system has, lack sufficient reliability, and will never achieve comprehensive and timely coverage of the whole range of health care. We propose a new approach that we believe will be more cost effective and that could meet these challenges.

Need for consensus

Most professional societies and national agencies in North America, Australia, and Europe recognise that guidelines cannot be based on research evidence alone. To paraphrase the philosopher David Hume: "ought" statements such as guidelines cannot be constructed from "is" statements such as research evidence.¹ The conversion from is to ought inevitably introduces value judgments about underlying goals and, in this context, . . . [Full text of this article]

Current approaches to developing guidelines

Methodological and practical concerns

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Suggestions for a way forward

New approach

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Rapid Responses:

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Is it evidence or opinion based medicine?

Navneet Singh
bmj.com, 20 Sep 2005 [Full text]

Improving methods of clinical guideline development

David Wonderling, et al.
bmj.com, 21 Sep 2005 [Full text]

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