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USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP

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Presentation on theme: "USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP"— Presentation transcript:

1 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS

2 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS What are guidelines? Why are guidelines needed? How are guidelines developed? Available resources.

3 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS What are guidelines? “Practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” James , 1995

4 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS What are the purpose of guidelines? “Convert science-based knowledge to clinical action and connect outcomes research to clinical practice.” “Allow respected professional judgment to advise on what needs to be done.” James 1995

5 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS What guidelines are not? Guidelines are not “old-hat” or impossible to practice Guidelines are not “cook book medicine” Guidelines are not cost cutting medicine

6 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Eliminate variability in patient care Improve quality of care Provide an outline of “current medical knowledge” Provide a tool to measure quality Avoid medical errors Medicine is dynamic-New therapies, technology, etc. Medical/legal reasons Optimization of medical resources Requirement for accreditation

7 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Variability of practice “Variation is the fat in the system that needs to be reduced.” (James 1995) Quality suffers as variability increases Goal is to decrease variability in the process to eliminate uncertainty and the steps that people take to protect themselves from uncertainty

8 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Improve quality of care delivered IOM Definition of Quality  ”The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. “ Guidelines provide: A system to identify “current professional knowledge” A system to monitor treatment according to “current professional knowledge”

9 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Improve quality of care delivered Guidelines provide a tool to measure quality of care provided “Everyone wants measures, but no one wants to be measured!” Author unknown

10 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Medicine is dynamic, with new therapies and technologies being added very often. This is especially true in cancer treatment. “Medicine ... is mobile, and many of us get breathless not so much by trying to keep up with medical progress as by trying to avoid being run over by it.” Roger I. Lee, 1958

11 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Medical/legal reasons for utilization of guidelines Guidelines provide an accepted standard of practice Practicing outside of these guidelines can leave exposure to lawsuits for failure to diagnosis or provide appropriate treatment.

12 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Optimization of Medical Resources Guidelines can help to eliminate unnecessary use of medical resources -Eliminate use of unnecessary tests - Eliminate use of unnecessary treatment -Optimize follow-up Guidelines can provide a standard for utilization of expensive technology Guidelines can help eliminate unnecessary procedures

13 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Why are guidelines needed? Requirement of accreditation Commission on Cancer Accreditation of cancer programs Require utilization of national guidelines Insurance companies request whether cancer patients are treated according to national guidelines

14 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS HOW ARE GUIDELINES DEVELOPED?

15 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS HOW ARE GUIDELINES DEVELOPED? 2 Methods of Guideline Development 1. Evidence based guidelines-Also describe the strength of the evidence and try to separate opinion from evidence. 2. Consensus Guidelines-The most common type. Rely on the subjective agreement of experts.

16 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Important aspects when evaluating guidelines for use? Are the results valid?   Were all important options and outcomes specified?   Was an explicit and sensible process used to identify, select and combine the evidence?   Was an explicit and sensible process used to consider the relative value of different  outcomes?   Were important recent developments included?   Has the guideline had peer review and testing?

17 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Important aspects when evaluating guidelines for use? What are the recommendations?   Are practical, important recommendations made?   How strong are the recommendations?   Could the uncertainty in the evidence or values change the guideline's recommendations?

18 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS Important aspects when evaluating guidelines for use? Will the results help me in patient care? Is the objective of the guideline consistent with mine?   Are the recommendations applicable to my patients?   Did the study have a sufficiently large sample size?

19 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS AVAILABLE RESOURCES ASCO GUIDELINES ( NCCN GUIDELINES ( NCI GUIDELINES ( National Guidelines Clearinghouse (

20 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS NCCN GUIDELINES Developed by experts from the National Comprehensive Cancer Network Available on-line or on a CD ROM Also have treatment guidelines for patients available Updated multiple times/year National Conference annually Specialty Conferences periodically at various sites

21 NCCN GUIDELINES

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25 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS

26 ASCO GUIDELINES

27 ASCO GUIDELINES

28 USING NATIONAL GUIDELINES FOR SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS SUMMARY Guidelines are effective tools for use by clinicians in screening for cancer, treatment, and follow-up of cancer patients. Guidelines should be evidenced based, current, and applicable to the population being treated. Guidelines can improve quality of care provided to cancer patients by eliminating variability.


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