The AGREE collaboration has introduced a new research-based version of its instrument to assess the quality of clinical guidelines and the reporting of the underlying development process. 1,2
This version maintains the same six quality-defining domains that underpinned the original AGREE approach: scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; applicability; and editorial independence. By keeping these domains, the AGREE collaborators seem to imply that they do not consider an extension necessary.
Perhaps the guidelines (and tools) should explicitly help their users put the clinical guidance offered into practice in ethically competent ways. As acknowledged in the CanMEDS framework, 3 health care professionals need robust ethical competence to provide patient care. This is not only relevant in dramatic life-or-death situations, but also in the increasingly complex reality of everyday practice, where potential issues are usually less striking but far more common and often no less important. 4
It is premature to propose adding an ethical component to the AGREE domains. Instead, we advocate research to explore how the codes of ethics for different professions can be supplemented with treatment-specific materials, how the process of developing such materials can be systematized in the spirit of AGREE, and how such materials can be used to increase ethically competent attitudes and behaviour in everyday patient care.
Footnotes
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For the full letter, go to: www.cmaj.ca/cgi/eletters/182/10/1045#595795