TREATMENT GUIDELINES- A NECESSITY DR LASEBIKAN NWAMAKA

OUTLINE DEFINITION IMPORTANCE UNDERSTANDING GUIDELINES BENEFITS LIMITATIONS THE UNTH EXPERIENCE

WHAT ARE GUIDELINES “……systematically developed statements to assist in practitioner and patient decisions about appropriate health care for specific clinical circumstances…….”

ACCORDING TO AHRQ

IMPORTANCE OF GUIDELLINES  To improve the quality of care  Assess the clinical and cost effectiveness of treatments and ways of managing a particular condition  Are based on the best available research evidence and expert consensus  Are developed using recommended methods that are robust and transparent  As a reference when wide regional variations exist in managing a condition “…..clinical practice guidelines are becoming more prominent as a key metric of quality healthcare…..”

BENEFITS… Guidelines help clinicians translate best evidence into best practice. A well- crafted guideline promotes quality by reducing healthcare variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective – or potentially harmful – interventions.

UNDERSTANDING GUIDELINES USEFUL TOOLS - AGREE - COGS Guidelines are one way of implementing evidence into practice. They can serve as a guide to best practices, a framework for clinical decision-making, and a benchmark for evaluating performance. Guidelines benefit patients through better outcomes, fewer ineffective interventions, greater consistency of care, and by creating secondary implementation materials (pamphlets, videos, etc.). Clinicians can use guidelines to make better decisions, initiate quality improvement efforts, prioritize new research initiatives, and support coverage or reimbursement for appropriate services. Conversely a flawed guideline could significantly harm both patients and clinicians, thereby mandating sound methodology as a basis for guideline development.

Potential limitations of guidelines Wrong recommendation- guideline developers may err in determining what is best for patients for three important reasons. Firstly, scientific evidence about what to recommend is often lacking, misleading, or misinterpreted.. Secondly, recommendations are influenced by the opinions and clinical experience and composition of the guideline development group Thirdly, patients’ needs may not be the only priority in making recommendations.

Potential harms to healthcare professionals Flawed clinical guidelines harm practitioners by providing inaccurate scientific information and clinical advice, thereby compromising the quality of care. They may encourage ineffective, harmful, or wasteful interventions

THE UNTH EXPERIENCE THE CANCER CARE CONTINUUM

THE PROCESS- Conception – Conclusion…..9months -AGREE -NICE -NCCN DEVELOPED USING RECOGNIZED METHODS THAT ARE ROBUST,OBJECTIVE, SCIENTIFICALY VALID, CONSISTENT AND WORKABLE IN UNTH. DEVELOPMENT INVOLVED ALL IDENTIFIED MULTISECTORIAL AND MULTIDISCIPLENARY STAKEHOLDERS INVOLVED IN THE CARE OF PATIENTS WITH BREAST CANCER

THE SCOPE Purpose of the scope provide an overview of what the guideline will cover. It also identifies the population involved, key clinical issues and itemizes main outcome of intervention. UNTH DRAFT SCOPE “the clinical management of breast cancer will operate using a framework of decision making tools spanning the entire cancer care continuum, from cancer prevention/screening to end of life care in keeping with global best practices. The expected outcome of the development of this protocol includes; To improve the quality of care offered, as recommendations are based on the best available research evidences and expert consensus Improve overall survival and other health monitoring indices including quality of life To assess the clinical and cost effectiveness of treatments and ways of managing breast cancer”

Examples of key issues and questions that could be included in draft scopes for consultation Identify Issues relating to services - develop key questions relating to services Identify Issues relating to interventions -develop key questions relating to interventions Identify Issue relating to experience of people using services - develop key question relating to experience of people using services Identify key question relating to health inequalities and equality Are there population groups, including those sharing a protected characteristic, who may be affected by poor access to service or treatment?

The Process INAUGURATION OF THE GUIDELINE DEVELOPMENT GROUP : - DEVELOPMENT OF REVIEW QUESTIONS- USING “PICO” DEFINE REVIEW STRATEGY REVIEW RESEARCH EVIDENCE AND APPLYING TO UNTH WRITING UP THE GUIDELINE RECOMMENDATIONS

Work Plan 1 st Phase – January 28 th 2017 Initiation of project Organization of protocol development committee and inauguration of subcommittees Decide on review questions Lay out plans/methodology for decisions reached 2 nd Phase - 30 th January- 31 st March 2017 Guideline Development for each subcommittee Literature Search/call for evidence from stakeholders Development of draft guideline( 20 th March- 31 st March) 3 rd Phase – 3 rd April – 22 nd April Consultations/ stakeholders review draft document (3 rd – 7 th April) Guideline revised in response to stakeholder comments (10 th – 14 th April) Finalized guideline sent to all stakeholders ahead of publication (17 th – 20 th April)

STRENGTHS – MULTIDISCIPLENARY PLATFORM. – DEDICATED, KNOWLEDGEABLE PROFFESSIONALS WILLING TO PARTNER TOGETHER – INSTITUITIONAL SUPPORT – IT Support-whassap platform – TECHNICAL SUPPORT FROM ROCHE

WEAKNESS/CHALLENGES – DIVERGENT VIEWS – UNMET TIMELINES – POOR COMMITMENT FROM IDENTIFIED STAKEHOLDERS LIMITATION OF RECOGNIZED BEST STANDARD OF CARE TREATMENT OPTIONS CARING FOR THE ECONOMICALY DISADVANTAGED PATIENTS

OPPORTUNITIES EXPAND CONTENT EXPAND COVERAGE TO INCLUDE OTHER COMMON CANCERS AND ECONOMIC EVALUATION

MEASURABLE TIMELINES IMPLEMENTATION TRACK EARLY REFERRALS NAVIGATION MULTIDISCIPLINARY MEETING EARLY REFERRAL TO PALLIATIVE CARE TREATMENT OUTCOME

RESULTS OF SURVEY

Strategies to support guideline uptake Pre-emptive identification of potential barriers of recommendations, and a prior generation of solutions to address them by the guideline development group. At a minimum the guideline group should be aware of the potential barriers; Use of behaviorally specific language in the guideline Use of multiple formats and channels for guideline dissemination based on preferences of the target group of health care practitioners; Development of educational resources adapted in content, and vehicle to each target group of health care practitioners; Identification of the resource implications of recommendations, ensuring their availability before starting; Use of data collection tools (for example, simple audit templates). Ref: Gagliardi et al. How can we improve guideline use? A conceptual framework of implementability. Implementation Science 2011, 6:26.

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