CLINICAL PRACTICE GUIDELINES: FACILITATING THEIR USE AND ENHANCING THEIR TRUSTWORTHINESS

Abstract

Clinicians in general value the use of the best evidence in decision-making and consider that can improve patient care. However, a successful evidence based practice is hard to achieve in real life. In recent years, with the consolidation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the development of improved standards to judge the trustworthiness of guideline recommendations and the adoption of more strict policies to limit the influence of conflict of interests, trustworthy guidelines have become an attractive alternative for an evidence-based clinical practice. In this thesis we offer an explicit and easy-to-use guidance to clinicians regarding how to use guideline recommendations in the context of a real life practice. We also provide an in-depth explanation of the judgments involved in determining the direction and strength of recommendations. Finally, we expand the knowledge about how to manage conflict of interests in guideline developers. Through two studies evaluating the conflict of interest policy implemented at the American College of Chest Physicians 9th edition of the Antithrombotic Guidelines, we show what aspects of the policy were successful and what aspects need to be reformulated.