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Ignacio Neumann - One of the best experts on this subject based on the ideXlab platform.
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Senior GRADE Methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis
Journal of Clinical Epidemiology, 2015Co-Authors: Paul E. Alexander, Michael R. Gionfriddo, Rebecca J. Stoltzfus, Ignacio Neumann, Juan P. Brito, Benjamin Djulbegovic, Victor M. Montori, Holger J. Schünemann, Gordon H. GuyattAbstract:Abstract Background The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. Objective To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly regarding discordant recommendations. Data sources Senior active GRADE Methodologists who had served on at least two WHO panels and were an author on at least one peer-reviewed published article on GRADE methodology. Methods Five eligible Methodologists participated in detailed semistructured interviews. Respondents answered questions regarding how they were viewed by other panelists and WHO leadership, and how they handled situations when panelists made discordant recommendations they felt were inappropriate. They also provided information on how the process can be improved. Interviews were recorded and transcribed, and inductive content analysis was used to derive codes, categories, and emergent themes. Results Three themes emerged from the interviews of five Methodologists: (1) The perceived role of Methodologists in the process, (2) Contributors to discordant recommendations, and (3) Strategies for improvement. Salient findings included (1) a perceived tension between Methodologists and WHO panels as a result of panel members' resistance to adhering to GRADE guidance; (2) both financial and nonfinancial conflicts of interest among panel members as an explanation for discordant recommendations; and (3) the need for greater clarity of, and support for, the role of Methodologists as co-chairs of panels. Conclusions These findings suggest that the role of the GRADE Methodologist as a co-chair needs to be clarified by the WHO leadership. They further suggest the need for additional training for panelists, quality monitoring, and feedback to ensure optimal use of GRADE in guideline development at WHO.
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P084 Experiences With The Novel Policy For Managing Conflicts Of Interest Implemented In The 9th Edition Of The American College Of Chest Physicians Antithrombotic Guidelines (At9)
BMJ Quality & Safety, 2013Co-Authors: Ignacio Neumann, Elie A. Akl, Renee Karl, Aman Rajpal, G. H. GuyattAbstract:Background The executive committee of the American College of Chest Physicians 9th edition of the Antithrombotic Guidelines (AT9) developed a novel policy for managing conflicts of interest (COI): Methodologists bore primary responsibility for each chapter; there was equal emphasis on intellectual and financial COI; and content experts with COI participated, but the intent was to exclude them from the final decisions on recommendations on which they had conflicts. Objectives To explore the experiences of the AT9 Methodologists and content experts with the COI policy. Methods A descriptive qualitative study: We conducted two rounds of semi-structured interviews with 15 participants and presented the results to the remaining 4 for verification. Results Methodologists were more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other 4 content experts remained sceptical, especially regarding the emphasis on intellectual COI. It was not possible to completely exclude conflicted panellists from the final decisions of the recommendations on which they had COI. Discussion After its implementation, some content experts were more favourable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations. Implications for Guideline Developers/Users The leading role of Methodologists was a positive innovation. However, restrictions to conflicted panellists were difficult to fully implement.
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experiences with a novel policy for managing conflicts of interest of guideline developers a descriptive qualitative study
Chest, 2013Co-Authors: Renee Karl, Ignacio Neumann, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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experiences with a novel policy for managing conflicts of interest of guideline developers
Chest, 2013Co-Authors: Renee Karl, Ignacio Neumann, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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Experiences With a Novel Policy for Managing Conflicts of Interest of Guideline Developers: A Descriptive Qualitative Study
Chest, 2013Co-Authors: Ignacio Neumann, Elie A. Akl, Renee Karl, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
Gordon H. Guyatt - One of the best experts on this subject based on the ideXlab platform.
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Senior GRADE Methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis
Journal of Clinical Epidemiology, 2015Co-Authors: Paul E. Alexander, Michael R. Gionfriddo, Rebecca J. Stoltzfus, Ignacio Neumann, Juan P. Brito, Benjamin Djulbegovic, Victor M. Montori, Holger J. Schünemann, Gordon H. GuyattAbstract:Abstract Background The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. Objective To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly regarding discordant recommendations. Data sources Senior active GRADE Methodologists who had served on at least two WHO panels and were an author on at least one peer-reviewed published article on GRADE methodology. Methods Five eligible Methodologists participated in detailed semistructured interviews. Respondents answered questions regarding how they were viewed by other panelists and WHO leadership, and how they handled situations when panelists made discordant recommendations they felt were inappropriate. They also provided information on how the process can be improved. Interviews were recorded and transcribed, and inductive content analysis was used to derive codes, categories, and emergent themes. Results Three themes emerged from the interviews of five Methodologists: (1) The perceived role of Methodologists in the process, (2) Contributors to discordant recommendations, and (3) Strategies for improvement. Salient findings included (1) a perceived tension between Methodologists and WHO panels as a result of panel members' resistance to adhering to GRADE guidance; (2) both financial and nonfinancial conflicts of interest among panel members as an explanation for discordant recommendations; and (3) the need for greater clarity of, and support for, the role of Methodologists as co-chairs of panels. Conclusions These findings suggest that the role of the GRADE Methodologist as a co-chair needs to be clarified by the WHO leadership. They further suggest the need for additional training for panelists, quality monitoring, and feedback to ensure optimal use of GRADE in guideline development at WHO.
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experiences with a novel policy for managing conflicts of interest of guideline developers a descriptive qualitative study
Chest, 2013Co-Authors: Renee Karl, Ignacio Neumann, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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experiences with a novel policy for managing conflicts of interest of guideline developers
Chest, 2013Co-Authors: Renee Karl, Ignacio Neumann, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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Experiences With a Novel Policy for Managing Conflicts of Interest of Guideline Developers: A Descriptive Qualitative Study
Chest, 2013Co-Authors: Ignacio Neumann, Elie A. Akl, Renee Karl, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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Methodologists and context experts disagreed regarding managing conflicts of interest of clinical practice guidelines panels.
Journal of Clinical Epidemiology, 2012Co-Authors: Elie A. Akl, Renee Karl, Gordon H. GuyattAbstract:Abstract Objective A new strategy to manage conflicts of interests (COIs) of a clinical guideline’s panelists gives primary responsibility to a Methodologist, puts equal emphasis on intellectual and financial COIs, and excludes panelists with primary conflicts from drafting or voting on recommendations. We explored the views of the Methodologists and content experts regarding the new strategy. Study Design and Setting Before the guidelines chapter panels initiated their work, we conducted semi-structured personal interviews with the Methodologists and the lead content experts. We analyzed the data qualitatively. Results Twenty-four panelists participated. The Methodologists thought that the new strategy increased their responsibility and authority. The lead content experts perceived their role label as unfair and reflecting a demotion. Whereas Methodologists were concerned about potential conflicts with content experts, the lead content experts were uncomfortable with the “extra surveillance” by the Methodologists. Whereas Methodologists believed that the changes ensure more rigorous evidence-based guidelines, some lead content experts were worried that Methodologists’ lack of content expertise and content expert attrition could hurt the quality of the guidelines. Conclusions The Methodologists and lead content experts were uneasy regarding their counterpart’s role. They disagreed about the potential effect of the new strategy on the quality of the guideline.
Miguel Ferrer - One of the best experts on this subject based on the ideXlab platform.
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an official american thoracic society american college of chest physicians clinical practice guideline liberation from mechanical ventilation in critically ill adults rehabilitation protocols ventilator liberation protocols and cuff leak tests
American Journal of Respiratory and Critical Care Medicine, 2017Co-Authors: Timothy D Girard, Waleed Alhazzani, John P Kress, Daniel R Ouellette, Gregory A Schmidt, Jonathon D Truwit, Suzanne M Burns, Scott K Epstein, Andres Esteban, Miguel FerrerAbstract:Background: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults.Methods: Two Methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation. The Methodologists appraised the certainty in the evidence (i.e., the quality of evidence) using the Grading of Recommendations, Assessment, Development, and Evaluation approach and summarized the results in evidence profiles. The guideline panel then formulated recommendations after considering the balance of desirable consequences (benefits) versus undesirable consequences (burdens, adverse effects, and costs), the certainty in the evidence, and the feasibility and acceptability of various interve...
Timothy D Girard - One of the best experts on this subject based on the ideXlab platform.
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an official american thoracic society american college of chest physicians clinical practice guideline liberation from mechanical ventilation in critically ill adults rehabilitation protocols ventilator liberation protocols and cuff leak tests
American Journal of Respiratory and Critical Care Medicine, 2017Co-Authors: Timothy D Girard, Waleed Alhazzani, John P Kress, Daniel R Ouellette, Gregory A Schmidt, Jonathon D Truwit, Suzanne M Burns, Scott K Epstein, Andres Esteban, Miguel FerrerAbstract:Background: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults.Methods: Two Methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation. The Methodologists appraised the certainty in the evidence (i.e., the quality of evidence) using the Grading of Recommendations, Assessment, Development, and Evaluation approach and summarized the results in evidence profiles. The guideline panel then formulated recommendations after considering the balance of desirable consequences (benefits) versus undesirable consequences (burdens, adverse effects, and costs), the certainty in the evidence, and the feasibility and acceptability of various interve...
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An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests
American Journal of Respiratory and Critical Care Medicine, 2017Co-Authors: Timothy D Girard, Waleed Alhazzani, John P Kress, Daniel R Ouellette, Gregory A Schmidt, Jonathon D Truwit, Suzanne M Burns, Scott K Epstein, Andres Esteban, Eddy FanAbstract:Background: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults.Methods: Two Methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation. The Methodologists appraised the certainty in the evidence (i.e., the quality of evidence) using the Grading of Recommendations, Assessment, Development, and Evaluation approach and summarized the results in evidence profiles. The guideline panel then formulated recommendations after considering the balance of desirable consequences (benefits) versus undesirable consequences (burdens, adverse effects, and costs), the certainty in the evidence, and the feasibility and acceptability of various interve...
Renee Karl - One of the best experts on this subject based on the ideXlab platform.
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P084 Experiences With The Novel Policy For Managing Conflicts Of Interest Implemented In The 9th Edition Of The American College Of Chest Physicians Antithrombotic Guidelines (At9)
BMJ Quality & Safety, 2013Co-Authors: Ignacio Neumann, Elie A. Akl, Renee Karl, Aman Rajpal, G. H. GuyattAbstract:Background The executive committee of the American College of Chest Physicians 9th edition of the Antithrombotic Guidelines (AT9) developed a novel policy for managing conflicts of interest (COI): Methodologists bore primary responsibility for each chapter; there was equal emphasis on intellectual and financial COI; and content experts with COI participated, but the intent was to exclude them from the final decisions on recommendations on which they had conflicts. Objectives To explore the experiences of the AT9 Methodologists and content experts with the COI policy. Methods A descriptive qualitative study: We conducted two rounds of semi-structured interviews with 15 participants and presented the results to the remaining 4 for verification. Results Methodologists were more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other 4 content experts remained sceptical, especially regarding the emphasis on intellectual COI. It was not possible to completely exclude conflicted panellists from the final decisions of the recommendations on which they had COI. Discussion After its implementation, some content experts were more favourable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations. Implications for Guideline Developers/Users The leading role of Methodologists was a positive innovation. However, restrictions to conflicted panellists were difficult to fully implement.
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experiences with a novel policy for managing conflicts of interest of guideline developers
Chest, 2013Co-Authors: Renee Karl, Ignacio Neumann, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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experiences with a novel policy for managing conflicts of interest of guideline developers a descriptive qualitative study
Chest, 2013Co-Authors: Renee Karl, Ignacio Neumann, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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Experiences With a Novel Policy for Managing Conflicts of Interest of Guideline Developers: A Descriptive Qualitative Study
Chest, 2013Co-Authors: Ignacio Neumann, Elie A. Akl, Renee Karl, Aman Rajpal, Gordon H. GuyattAbstract:Background The executive committee of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) developed a novel policy for managing conflicts of interest (COIs): Methodologists bore primary responsibility for each chapter, there was equal emphasis on intellectual and financial COI, and content experts with COIs participated, but with restrictions for recommendations on which they had conflicts. The objective of this study was to explore the experiences of the Methodologists and content experts with the COI policy after its implementation. Methods One investigator conducted two rounds of semistructured interviews with the Methodologist and the leading content expert of each chapter until data saturation was achieved. Two investigators analyzed the transcripts of the interviews in duplicate using an immersion-crystallization approach. We also conducted member checking. Results We interviewed 15 participants and presented the results to the remaining four for verification. In comparison with their views expressed prior to AT9 development, Methodologists remained more positive about the policy than content experts. Six of 10 content experts expressed a more positive view than prior to participation in the AT9 process. The other four content experts remained skeptical, especially regarding the emphasis on intellectual COI. The restrictions of the policy on conflicted individuals were not fully implemented. Conclusions After its implementation, some content experts were more favorable to the policy, but some retained major reservations. The influence of the policy on recommendations may have been more through the leading role of the Methodologists than exclusion of conflicted participants in making recommendations.
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Methodologists and context experts disagreed regarding managing conflicts of interest of clinical practice guidelines panels.
Journal of Clinical Epidemiology, 2012Co-Authors: Elie A. Akl, Renee Karl, Gordon H. GuyattAbstract:Abstract Objective A new strategy to manage conflicts of interests (COIs) of a clinical guideline’s panelists gives primary responsibility to a Methodologist, puts equal emphasis on intellectual and financial COIs, and excludes panelists with primary conflicts from drafting or voting on recommendations. We explored the views of the Methodologists and content experts regarding the new strategy. Study Design and Setting Before the guidelines chapter panels initiated their work, we conducted semi-structured personal interviews with the Methodologists and the lead content experts. We analyzed the data qualitatively. Results Twenty-four panelists participated. The Methodologists thought that the new strategy increased their responsibility and authority. The lead content experts perceived their role label as unfair and reflecting a demotion. Whereas Methodologists were concerned about potential conflicts with content experts, the lead content experts were uncomfortable with the “extra surveillance” by the Methodologists. Whereas Methodologists believed that the changes ensure more rigorous evidence-based guidelines, some lead content experts were worried that Methodologists’ lack of content expertise and content expert attrition could hurt the quality of the guidelines. Conclusions The Methodologists and lead content experts were uneasy regarding their counterpart’s role. They disagreed about the potential effect of the new strategy on the quality of the guideline.