Methodological recommendations for variability quantification methods applied in the formulation of clinical questions in guidelines_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Yicheng ^1,2,3 , LIU Meijun ^1,2,3 , SU Chengyuan ^1,2,3 , WANG Yaqi ^1,2,3 , FENG Yuting ^1,2,3 , CAO Rui ^1,2,3 , LIU Zhihan ^1,2,3 ,  FEI Yutong ^1,2,3

1. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
2. Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
3. Beijing GRADE Center, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;

Corresponding author：

FEI Yutong, Email: yutong_fei@163.com

Keywords：

Clinical question; Variability; Priority; Methodology; Clinical practice guideline

DOI：

10.7507/1672-2531.202306003

Video：

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When prioritizing clinical questions in the development of the clinical practice guidelines, clinical questions with high recognition and low variability, or high score and less disagreement among experts were often prioritized, while questions with high recognition but high variability were excluded. By this approach, clinical questions with practical value but also showed high variability due to different causes were not accepted as priorities. There were some methodological and clinical limitations by doing so. By summarizing the causes and connotations of expert opinion variability in terms of clinical experience, expertise and values, this paper analyzed the advantages of the variability quantification application, and proposed corresponding methodological recommendations, so as to provide references for guideline developers in the priority selection of clinical questions.

Citation： GAO Yicheng, LIU Meijun, SU Chengyuan, WANG Yaqi, FENG Yuting, CAO Rui, LIU Zhihan, FEI Yutong. Methodological recommendations for variability quantification methods applied in the formulation of clinical questions in guidelines. Chinese Journal of Evidence-Based Medicine, 2023, 23(11): 1329-1333. doi: 10.7507/1672-2531.202306003 Copy

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18.	肖晶旻, 谢倩文, 刘少南, 等. 循证中医药实践中患者价值观及偏好研究的概括性评价. 中医杂志, 2019, 60(24): 2089-2094.
19.	李元, 韩学杰, 王丽颖. 中医临床实践指南共识专家遴选方法. 北京中医药, 2021, 40(9): 1002-1004.
20.	周奇, 王琪, 俞阳, 等. 临床实践指南制定中的共识方法. 药品评价, 2016, 13(16): 13-17.
21.	周殷华, 程瑜. 国际干细胞医疗市场治理与医生的职业价值观. 广西民族大学学报(哲学社会科学版), 2017, 39(1): 20-26.
22.	王伟, 陈军. 生命价值观视角下医生对患者的态度调查. 中国医学伦理学, 2016, 29(6): 963-965.
23.	柳兰萍, 杨越, 黄漫, 等. 基于改良德尔菲法构建《非特异性腰痛针灸临床实践指南》临床问题. 中国全科医学, 2023, 26(9): 1037-1043.
24.	黄喜, 吕伯东, 胡青, 等. 基于Delphi法的《石淋病中医临床诊疗指南》问卷调查与结果分析. 浙江中西医结合杂志, 2021, 31(1): 84-86.
25.	Xing D, Wang Q, Yang Z, et al. Evidence-based guidelines for intra-articular injection in knee osteoarthritis: formulating and evaluating research questions. Int J Rheum Dis, 2018, 21(8): 1533-1542.
26.	National Institute for Health and Care Excellence (NICE). Developing NICE guidelines the manual. 2020.
27.	American Academy of Neurology. Clinical practice guideline process manual. 2017.
28.	The American College of Occupational and Environmental Medicine. Practice guidelines methodology. 2017.
29.	Minds Guideline Center, Japan Council for Quality Health Care (2021). Minds handbook for clinical practice guideline development. 2021.
30.	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): 839-842.
31.	Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
32.	杨楠, 赵巍, 潘旸, 等. 针对临床实践指南科学性、透明性和适用性的评级工具研发. 中华医学杂志, 2022, 102(30): 2329-2337.

1. Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol, 2011, 64(4): 395-400.
2. Institute of Medicine. Clinical practice guidelines we can trust. Washington (DC): The National Academies Press, 2011: 16-25.
3. Murphy MK, Black NA, Lamping DL, et al. Consensus development methods, and their use in clinical guideline development. Health Tech Assess, 1998, 2(3): 1-88.
4. Chapple M, Murphy R. The nominal group technique: extending the evaluation of students' teaching and learning experiences. Assess Eval High Edu, 1996, 21(2): 147-160.
5. Custer RL, Scarcella JA, Stewart BR. The modified Delphi technique a rotational modification. J Vcat Tech Edu, 1999, 15(2): 1-10.
6. Oxman AD, Schünemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 2. Priority setting. Health Res Policy Syst, 2006, 4: 14.
7. Atkins D, Perez-Padilla R, Macnee W, et al. Priority setting in guideline development: article 2 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proc Am Thorac Soc, 2012, 9(5): 225-228.
8. El-Harakeh A, Morsi RZ, Fadlallah R, et al. Prioritization approaches in the development of health practice guidelines: a systematic review. BMC Health Serv Res, 2019, 19(1): 692.
9. Speckman RA, Friedly JL. Asking structured, answerable clinical questions using the population, intervention/comparator, outcome (PICO) framework. PM R, 2019, 11(5): 548-553.
10. Morgan RL, Whaley P, Thayer KA, et al. Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int, 2018, 121(Pt 1): 1027-1031.
11. Chakraborty S, Brijnath B, Dermentzis J, et al. Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions. Health Res Policy Syst, 2020, 18(1): 113.
12. Fadlallah R, El-Harakeh A, Bou-Karroum L, et al. A common framework of steps and criteria for prioritizing topics for evidence syntheses: a systematic review. J Clin Epidemiol, 2020, 120: 67-85.
13. Wiercioch W, Nieuwlaat R, Zhang Y, et al. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol, 2022, 143: 91-104.
14. Zaror C, Deana NF, Espinoza-Espinoza G, et al. Questions and health outcomes prioritization for the development of a COVID-19 dental clinical practice guideline: a case study. J Eval Clin Pract, 2022, 28(3): 404-410.
15. 杨超, 杜世豪, 王舢泽, 等. 基于改良德尔菲法构建《女性尿失禁针灸临床实践指南》临床问题. 中国针灸, 2022, 42(8): 927-931.
16. 《中成药治疗优势病种临床应用指南》标准化项目组. 中成药治疗更年期综合征临床应用指南(2020年). 中国中西医结合杂志, 2021, 41(4): 418-426.
17. 高一城, 夏如玉, 柴倩云, 等. 组建患者小组: 将患者价值观与偏好整合融入指南制订过程的建议. 协和医学杂志, 2023(6): 1-13.
18. 肖晶旻, 谢倩文, 刘少南, 等. 循证中医药实践中患者价值观及偏好研究的概括性评价. 中医杂志, 2019, 60(24): 2089-2094.
19. 李元, 韩学杰, 王丽颖. 中医临床实践指南共识专家遴选方法. 北京中医药, 2021, 40(9): 1002-1004.
20. 周奇, 王琪, 俞阳, 等. 临床实践指南制定中的共识方法. 药品评价, 2016, 13(16): 13-17.
21. 周殷华, 程瑜. 国际干细胞医疗市场治理与医生的职业价值观. 广西民族大学学报(哲学社会科学版), 2017, 39(1): 20-26.
22. 王伟, 陈军. 生命价值观视角下医生对患者的态度调查. 中国医学伦理学, 2016, 29(6): 963-965.
23. 柳兰萍, 杨越, 黄漫, 等. 基于改良德尔菲法构建《非特异性腰痛针灸临床实践指南》临床问题. 中国全科医学, 2023, 26(9): 1037-1043.
24. 黄喜, 吕伯东, 胡青, 等. 基于Delphi法的《石淋病中医临床诊疗指南》问卷调查与结果分析. 浙江中西医结合杂志, 2021, 31(1): 84-86.
25. Xing D, Wang Q, Yang Z, et al. Evidence-based guidelines for intra-articular injection in knee osteoarthritis: formulating and evaluating research questions. Int J Rheum Dis, 2018, 21(8): 1533-1542.
26. National Institute for Health and Care Excellence (NICE). Developing NICE guidelines the manual. 2020.
27. American Academy of Neurology. Clinical practice guideline process manual. 2017.
28. The American College of Occupational and Environmental Medicine. Practice guidelines methodology. 2017.
29. Minds Guideline Center, Japan Council for Quality Health Care (2021). Minds handbook for clinical practice guideline development. 2021.
30. Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): 839-842.
31. Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
32. 杨楠, 赵巍, 潘旸, 等. 针对临床实践指南科学性、透明性和适用性的评级工具研发. 中华医学杂志, 2022, 102(30): 2329-2337.

Chinese Journal of Evidence-Based Medicine

Methodological recommendations for variability quantification methods applied in the formulation of clinical questions in guidelines

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