Spring 2017 (Volume 27, Number 1)

CRA Survey Results: Guidelines for Guidelines?

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Guidelines serve a very important role in healthcare and medical practice, particularly since the advances of evidence-based medicine over the past two decades. For the spring 2017 issue of Joint Count, we asked CRA members for their opinions on guidelines: why the CRA should develop them, what purposes they serve for CRA members, and the best ways to handle conflicts of interest (COI). The data below are based on responses from 140 CRA members, who are either academic and/or community rheumatologists.

When asked about why the CRA should develop high-quality clinical guidance documents, the majority of survey respondents agreed that the most important reasons are to help standardize clinical practices based on best evidence (79%); to provide guidance for CRA members on important clinical topics (77%); and to improve patient outcomes (76%).

According to CRA members, CRA guidelines are most often used in clinical practice (67%) and to improve knowledge (67%). They were also cited as being used in discussions with health policy experts or industry (33%); when writing research papers (25%); and as a reference for patients (16%). Many respondents also commented that they used CRA guidelines as teaching tools for medical students and trainees.

The most useful dissemination methods/products would be open-access to the full publication (71%), a short version of the guideline (67%) or a guidelines app (60%). Concerning a guidelines app, a quarter of respondents said summary tables of important risks and benefits for key recommendations would be helpful to have within the app.

Finally, with regard to how the CRA should handle COI within guidelines, most respondents (88%) agreed that there should be full disclosure of any COI or perceived COI, published alongside the guidelines. Almost half of respondents agreed that having guideline panelists excuse themselves (i.e., not vote) on recommendations where they have a real or perceived COI, could also help mitigate issues of COI.

While guidelines serve many uses in healthcare, their ultimate objectives are to improve patient care and health outcomes. With this in mind, it is paramount that they are rigorously developed by experts in the field who are using the best evidence available.