Table 1:

Options for the management of conflict of interests from various organizations

Option “category”	Group
Option “category”	National Institute for Health and Care Excellence (2018)25	United States Preventive Services Task Force (2018)26	Guidelines International Network (2015)12	World Health Organization (2014)23
Full involvement (disclosure only)	No action other than the process of open declaration — the person can engage in all aspects of the committee’s work. This is usually because nothing is considered to represent a perceived COI, but may in some circumstances be because an open declaration is considered sufficient to mitigate any risk of conflict. Open declaration will usually be sufficient if a financial interest occurred in the last 12 months and is no longer held; for example. In these cases, the potential to benefit has ceased.	Information disclosure only. Member may participate as primary lead,^* and discuss and vote on the topic.	Not applicable	No action required beyond declaration at the guideline development group meeting and reporting in the published guideline.
Limited involvement	The person can engage in committee discussion or provide advice (for example, because of their expert knowledge), but is excluded from developing recommendations and decision-making on the matter relating to their declared interest. Involvement may be limited to answering questions from the committee.	Member may not participate as the primary lead of the topic specific to the conflict, but may serve as a nonprimary lead^* on the topic workgroup and discuss and vote on the topic. Member may not participate as the primary spokesperson for the topic specific to the conflict, but may serve as a nonprimary lead on the topic workgroup and discuss and vote on the topic. Member may not participate as a lead in the topic workgroup specific to conflict, but may discuss and vote on the topic.	Panel members with any form of COI cannot be chairs of the working group. A co-chair with no COIs can be appointed if a chair with COI is unavoidable. Panel members with a relevant financial COI should not be involved in deciding about the direction or strength of a recommendation. These members should not participate in this phase of guideline development and should be physically absent from the discussion about the direction and strength of the recommendation.	The individual with the conflict may be excluded from the formulation of specific recommendations but allowed to participate in all discussions. The individual with the conflict may be barred from participating in discussions as well as in the formulation of the recommendations. They can be asked to leave the meeting during the development and ratification of any recommendations related to their COI.
No involvement (complete exclusion)	The person can have no input to a specific topic, either from the start (nonappointment) or for part of the committee’s work relating to that topic. It may be appropriate in these cases to withhold any confidential meeting papers for that item, especially when the person could benefit from the information.	Member may not participate as a lead on the topic workgroup specific to the conflict, or discuss or vote on the topic. Member will leave the meeting room for all discussion and voting. Member’s recusal will be denoted in the publicly released recommendations.	Not applicable	No participation is allowed — the COI is deemed serious enough to preclude membership in the guideline development group or participation as a contractor for the World Health Organization in a specific guideline development process.

Note: COI = conflict of interest.
↵* “Each topic team (see US Preventive Services Task Force Procedure Manual Section 1.9) includes the Agency for Healthcare Research and Quality Medical Officer, a Task Force chair or co-vice chair, representatives from the evidence-based practice center conducting the systematic evidence review, and several Task Force members, known as ‘leads.’ One of the Task Force leads serves as the primary lead for that topic.”2