Methodology

Governance

The Canadian Respiratory Guidelines Committee (CRGC), is a Standing Committee providing oversight to our standardized guidelines process, training, and knowledge translation expertise to the CTS Assemblies’ Guideline Working Groups. The Chair of the CRGC represents and reports on the progress of the Assemblies involved in the development of clinical practice guidelines to the CTS Board of Directors.

The CTS Assemblies which are broad-based interest group focussed on a particular clinical area in respiratory health.  The work of an Assembly is advisory to the CTS Board and its Standing Committees.  The Assemblies identify and develop priorities and programs in research, education and continuous professional development, and in the production of respiratory guidelines and their corresponding resources and tools.

The CTS Board of Directors appoints Chairs or Co-Chairs who then select the panel members trained in methodology to oversee the development of CTS guidelines and guidance documents in accordance with CTS policies and procedures. CTS ensures early career members are actively involved in the Society’s assembly guideline development and knowledge translation projects.

Guideline Development Process and Methodology

CTS Production Manual addresses all policies, procedures and approval processes related to the guideline development. It also describes the methods and tools validated by CTS for guideline development standardization. The PICO method is used to formulate optimal clinical questions. The AGREE II Instrument https://www.agreetrust.org/agree-ii/ guides development and is used again during the review process as an evaluation measure. In addition, the CTS has adopted the GRADE http://www.gradeworkinggroup.org/ scale for rating the strength of recommendations and the quality of evidence.

to ensure the success of downstream guideline implementation initiatives, CTS considers the intrinsic “implementability” of guidelines immediately at the stage of guideline production. This involves several areas:

Guideline Working Groups are encouraged to consider implementability and seek input from knowledge-users at the beginning of the guideline production process. When selecting clinical questions to address within guidelines, guideline developers will be asked to consult with end-users about which questions are most relevant, and to consider the following factors influencing implementability: the magnitude of the knowledge-to-care gap; target audience(s); known barriers and supports to implementation; possible implementation strategies; societal impact; and relevant metrics to be used in evaluating the success of the implementation program.

Guidelines will include a dedicated KT section which will describe each of these factors in relation to each of the recommendations considered by guideline producers to be top priorities for KT activities.

Features that are “intrinsic” to the way that a guideline is written and displayed also influence user perceptions and guideline uptake. As such, guideline writers will consider elements in the language and format domains of the evidence-based GUIDE-M framework, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364563/ and ensure optimized recommendation language and format before guidelines are finalized.

 

CTS Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation has three spheres of action: guideline production, implementation infrastructure and knowledge translation (KT) methodological support. The elements of the CTS Framework are intended to support Guideline Working Groups in planning, designing, and leading KT activities beginning with guideline production, continuing throughout implementation and ending with objective evaluation.

In 2006, Graham and colleagues studied over 60 planned action models, characterizing common elements in an effort to devise a comprehensive but practical framework for KT activities.  This approach, termed the “Knowledge-to-Action” http://www.cihr-irsc.gc.ca/e/41929.html  process, has since been broadly espoused by implementation researchers, recommended by the Canadian Institutes of Health Research, and herein designated as the CTS model for conceptualizing and developing KT interventions.

Implementability is a multi-dimensional construct comprised of a set of characteristics. To facilitate uptake, the process of guideline development has two broad aims: the creation of content and the communication of that content http://www.jclinepi.com/article/S0895-4356(15)00007-4/fulltext . The four domains of content creation are stakeholder involvement, evidence synthesis, considered judgment in formulating recommendations, and feasibility. The two domains of content communication relate to fine-tuning the message itself and its format.

http://www.cmaj.ca/content/cmaj/early/2016/04/18/cmaj.151102.full.pdf or key messages has to be simple, clear, and persuasive in order to reduce cognitive load, increase understanding and retention, and render convincing and salient arguments.  Correspondingly, level of complexity is inversely proportional to overall guideline adoption and recommendation adherence.  At the same time, a number of formatting aspects of guidelines can promote their use in practice. These include presentation aspects such as a user-friendly layout (e.g. considering document length and the placement of visual elements), structure (e.g. bundling information and matching the order and flow of recommendations to that of real-world practice), and how information is best visualized (e.g. conveying complex recommendations through tables, graphs and flowcharts).

See Knowledge Translation and Resources.

Conflict of Interest

CTS Guideline developers are functionally and editorially independent from any funding sources of the CTS and do not receive any direct funding from external sources. The CTS receives unrestricted grants which are combined into a central operating account to facilitate the knowledge translation activities of the CTS Assemblies. No funders play a role in the collection, review, analysis or interpretation of the scientific literature or in any decisions regarding the key messages presented in this document.

Members of the CTS guideline working groups declare potential conflicts of interest at the time of appointment and these are updated throughout the process in accordance with the CTS Conflict of Interest Disclosure Policy. Individual member conflict of interest statements are posted as part of our Guideline Library.