Table 3

Shortcomings and actions to improve guideline quality (Appraisal of Guidelines, Research and Evaluation domains)

Appraisal of Guidelines, Research and Evaluation domainDeficienciesActions
Scope and purpose
  1. Lack of information on purpose and target population.

  2. Lack of information about the scope or too broad scopes.

  1. Provide specific information and clear summaries, which is less time-consuming than improving the process or methodology.

  2. Consider limiting number the scope and/or the number of questions in each guideline. Focus on questions that are important to patients and clinicians. Panels for guideline development should prioritise their efforts and identify which questions should be answered first.

Stakeholder involvement
  1. Lack of multidisciplinary teams.

  2. Low participation of patients or no consideration of patients' views.

  1. Involve several related disciplines

  2. Contact patient organisation for feed-back at early stages and along the whole process, of guideline developing. Include patients in guideline panels. Consider searching for qualitative and other types of research about patients values and preferences.

Rigour of development
  1. Lack of methodogical expertise.

  2. Lack of information about methods.

  1. Involve librarians and methodologists in the guideline development process.

  2. Include more information about the methods in the guidelines. Use addenda for including search strategies, databases consulted, literature selection process, system used to evaluate the quality of the evidence and grading of recommendations, and evidence tables. In electronic documents, hyperlinks can be helpful.

Clarity and presentation
  1. Vague recommendations or statements that do not imply a specific action.

  2. Thick, textbook-like documents with recommendations hidden in the text. Lack of summaries for use in practice.

  1. Refrain from including material in guidelines that is not directly relevant to the needs of the guideline users.

  2. Avoid classic textbook-like guidelines. Minimise background sections. Provide specific information and clear summaries.

  1. Lack of information about the dissemination and implementation strategies.

  2. Absence of criteria for monitoring and/or audit.

  1. Need to integrate these issues in the development phase. Relevant professionals with the relevant expertise should be incorporated in the development group in early stages.

  2. Guideline groups should explicitly acknowledge the need to consider barriers, costs, indicators or criteria for monitoring locally when implementing or adapting a guideline.

Editorial independenceLack of or insufficient information on the presence of conflicts of interest in guideline developers (economic and/or intellectual)
  1. Public and explicit declaration of all type of conflicts of interest of guideline panels is a must.

  2. Institutions should be transparent about their conflicts of interest policies and funding sources. Guideline members should reveal any financial ties with industry and any potential intellectual conflicts. The latter includes authorship of studies or grant funding in a related area of healthcare.