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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16.	《中成藥治療優勢病種臨床應用指南》標準化項目組. 中成藥治療更年期綜合征臨床應用指南(2020年). 中國中西醫結合雜志, 2021, 41(4): 418-426.
17.	高一城, 夏如玉, 柴倩云, 等. 組建患者小組: 將患者價值觀與偏好整合融入指南制訂過程的建議. 協和醫學雜志, 2023(6): 1-13.
18.	肖晶旻, 謝倩文, 劉少南, 等. 循證中醫藥實踐中患者價值觀及偏好研究的概括性評價. 中醫雜志, 2019, 60(24): 2089-2094.
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20.	周奇, 王琪, 俞陽, 等. 臨床實踐指南制定中的共識方法. 藥品評價, 2016, 13(16): 13-17.
21.	周殷華, 程瑜. 國際干細胞醫療市場治理與醫生的職業價值觀. 廣西民族大學學報(哲學社會科學版), 2017, 39(1): 20-26.
22.	王偉, 陳軍. 生命價值觀視角下醫生對患者的態度調查. 中國醫學倫理學, 2016, 29(6): 963-965.
23.	柳蘭萍, 楊越, 黃漫, 等. 基于改良德爾菲法構建《非特異性腰痛針灸臨床實踐指南》臨床問題. 中國全科醫學, 2023, 26(9): 1037-1043.
24.	黃喜, 呂伯東, 胡青, 等. 基于Delphi法的《石淋病中醫臨床診療指南》問卷調查與結果分析. 浙江中西醫結合雜志, 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, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
32.	楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性、透明性和適用性的評級工具研發. 中華醫學雜志, 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. 楊超, 杜世豪, 王舢澤, 等. 基于改良德爾菲法構建《女性尿失禁針灸臨床實踐指南》臨床問題. 中國針灸, 2022, 42(8): 927-931.
16. 《中成藥治療優勢病種臨床應用指南》標準化項目組. 中成藥治療更年期綜合征臨床應用指南(2020年). 中國中西醫結合雜志, 2021, 41(4): 418-426.
17. 高一城, 夏如玉, 柴倩云, 等. 組建患者小組: 將患者價值觀與偏好整合融入指南制訂過程的建議. 協和醫學雜志, 2023(6): 1-13.
18. 肖晶旻, 謝倩文, 劉少南, 等. 循證中醫藥實踐中患者價值觀及偏好研究的概括性評價. 中醫雜志, 2019, 60(24): 2089-2094.
19. 李元, 韓學杰, 王麗穎. 中醫臨床實踐指南共識專家遴選方法. 北京中醫藥, 2021, 40(9): 1002-1004.
20. 周奇, 王琪, 俞陽, 等. 臨床實踐指南制定中的共識方法. 藥品評價, 2016, 13(16): 13-17.
21. 周殷華, 程瑜. 國際干細胞醫療市場治理與醫生的職業價值觀. 廣西民族大學學報(哲學社會科學版), 2017, 39(1): 20-26.
22. 王偉, 陳軍. 生命價值觀視角下醫生對患者的態度調查. 中國醫學倫理學, 2016, 29(6): 963-965.
23. 柳蘭萍, 楊越, 黃漫, 等. 基于改良德爾菲法構建《非特異性腰痛針灸臨床實踐指南》臨床問題. 中國全科醫學, 2023, 26(9): 1037-1043.
24. 黃喜, 呂伯東, 胡青, 等. 基于Delphi法的《石淋病中醫臨床診療指南》問卷調查與結果分析. 浙江中西醫結合雜志, 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, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
32. 楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性、透明性和適用性的評級工具研發. 中華醫學雜志, 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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