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Short Report

Process for guideline development by the reconstituted Canadian Task Force on Preventive Health Care

Sarah Connor Gorber, Harminder Singh, Kevin Pottie, Alejandra Jaramillo and Marcello Tonelli
CMAJ October 02, 2012 184 (14) 1575-1581; DOI: https://doi.org/10.1503/cmaj.120642
Sarah Connor Gorber
From the Public Health Agency of Canada (Connor Gorber, Jaramillo), Ottawa, Ont.; the Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; the Departments of Family Medicine and of Epidemiology and Community Medicine (Pottie), University of Ottawa, Ont.; and the Departments of Medicine and of Public Health Sciences (Tonelli), University of Alberta, Edmonton, Alta.
PhD
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  • For correspondence: [email protected]
Harminder Singh
From the Public Health Agency of Canada (Connor Gorber, Jaramillo), Ottawa, Ont.; the Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; the Departments of Family Medicine and of Epidemiology and Community Medicine (Pottie), University of Ottawa, Ont.; and the Departments of Medicine and of Public Health Sciences (Tonelli), University of Alberta, Edmonton, Alta.
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Kevin Pottie
From the Public Health Agency of Canada (Connor Gorber, Jaramillo), Ottawa, Ont.; the Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; the Departments of Family Medicine and of Epidemiology and Community Medicine (Pottie), University of Ottawa, Ont.; and the Departments of Medicine and of Public Health Sciences (Tonelli), University of Alberta, Edmonton, Alta.
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Alejandra Jaramillo
From the Public Health Agency of Canada (Connor Gorber, Jaramillo), Ottawa, Ont.; the Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; the Departments of Family Medicine and of Epidemiology and Community Medicine (Pottie), University of Ottawa, Ont.; and the Departments of Medicine and of Public Health Sciences (Tonelli), University of Alberta, Edmonton, Alta.
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Marcello Tonelli
From the Public Health Agency of Canada (Connor Gorber, Jaramillo), Ottawa, Ont.; the Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; the Departments of Family Medicine and of Epidemiology and Community Medicine (Pottie), University of Ottawa, Ont.; and the Departments of Medicine and of Public Health Sciences (Tonelli), University of Alberta, Edmonton, Alta.
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Article Figures & Tables

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    Table 1:

    Criteria for selecting topics for recommendations of the Canadian Task Force on Preventive Health Care

    CriteriaExplanationSource of information*
    Stage 1: Developing a short list of potential topics
    Timing of most recent reviewPriority is given to topics that have not been examined by the task force within the past 5 years.
    Availability of new evidencePriority is given to topics for which new or controversial evidence, which might lead to a change in existing recommendations, has emerged since the last time the topic was reviewed by the task force.
    Input from primary care practitionersPriority is given to topics that will address the needs of primary care practitioners.
    Stage 2: Ranking the final leading topics
    Disease burdenPrevalence, mortality, comorbidity, quality of life and expected effectiveness of the preventive service in decreasing that burden are assessed.Summaries of literature reviews and stakeholder consultations are developed and provided.
    Potential impact of recommendations in clinical practiceRating is done of whether there is the potential of a recommendation in a field to improve clinical practice and patient outcomes.Summary of stakeholder consultations is developed and provided.
    Interest of the public or care providersPriority is given to topics that have been recommended by practitioners or stakeholders.Summary of stakeholder consultations is developed and provided.
    Variation in carePriority is given to preventive services that have the potential to decrease variations in care.Summaries of literature reviews and stakeholder consultations are developed and provided.
    Sufficiency of evidenceA preliminary scan is conducted to determine whether there is evidence to answer key research questions.Summary of literature reviews is developed and provided.
    New evidencePriority is given especially to high-quality evidence in a stable field.Summaries of literature reviews and stakeholder consultations are developed and provided.
    • ↵* This information is developed by the task force scientific officers with assistance from the Evidence Review and Synthesis Centre, and is provided to the topic prioritization work group.

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    Table 2:

    Comparison of methods currently used by major international guideline-producing bodies

    Guideline groupTopic selectionConflicts of interestMembersStakeholder involvementReview processMethod for summarizing evidence
    WHO (9)Topics recommended internally by WHO departmentsDeclared and publishedDifferent group for each guideline
    Groups are multidisciplinary and include content experts, methodologists and end users; consumer involvement is encouraged
    Review documents and participate in guideline work groupResearch questions (experts and end users)
    Systematic review protocol and evidence tables (experts)
    Guidelines (experts and organizational reviewers)
    GRADE
    US Preventive Services Task Force (8)Topics nominated by the public, task force members and stakeholdersDeclared, not publishedMultidisciplinary panel of 16 health-related disciplines, nominated for 4-year term
    No consumers in the guideline work group
    Review and disseminate documents
    Briefing webinars offered on all guidelines
    New methods of stakeholder involvement are being tested
    Public comment on research plans, evidence review, guidelinesRecommendations graded as A, B, C or D reflecting whether the service is recommended
    “I” statements used if evidence is insufficient to make a recommendation
    National Institute for Health and Clinical Excellence (10)Topics selected by Department of Health but based on input from clinicians and publicDeclared and publishedClinical group differs for each guideline; technical members (search, research, synthesis) are constant
    Groups include health professionals, patient and caregiver representatives and registered stakeholders
    Involved in all steps throughout the process and as members of guideline work group DisseminationPublic consultation, peer reviewModified GRADE
    Recommendations are not rated as strong or weak
    Canadian Task Force on Preventive Health CareTopics nominated by public, task force members, stakeholders, literature reviewDeclared and posted on websiteMultidisciplinary panel of 14 methodologic, primary care and guideline experts, nominated for 3-year term
    Subset of a minimum of 3 task force members in each guideline work group
    No consumers in guideline work group
    Topic selection, review of documentsResearch question
    Systematic review protocol
    Evidence report and guidelines reviewed by experts, and subject-matter and generalist organizations
    GRADE
    • Note: GRADE = Grading of Recommendations Assessment, Development and Evaluation, WHO = World Health Organization.

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Canadian Medical Association Journal: 184 (14)
CMAJ
Vol. 184, Issue 14
2 Oct 2012
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Process for guideline development by the reconstituted Canadian Task Force on Preventive Health Care
Sarah Connor Gorber, Harminder Singh, Kevin Pottie, Alejandra Jaramillo, Marcello Tonelli
CMAJ Oct 2012, 184 (14) 1575-1581; DOI: 10.1503/cmaj.120642

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Process for guideline development by the reconstituted Canadian Task Force on Preventive Health Care
Sarah Connor Gorber, Harminder Singh, Kevin Pottie, Alejandra Jaramillo, Marcello Tonelli
CMAJ Oct 2012, 184 (14) 1575-1581; DOI: 10.1503/cmaj.120642
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