Recommended Changes

Recommended Changes

The Coalition for Responsible Healthcare Guidelines recommends the Task Force be restructured and existing guidelines corrected, overall processes be revamped, and a renewed commitment be made to the philosophy behind these guidelines.

Review overall processes and philosophy.

  1. Understand that guidelines are not purely academic exercises. The purpose of guidelines is to preserve Canadians’ health with judicious use of resources. Practical understanding of the topic is needed.
  2. Acknowledge conflicts of interest but prioritize the importance of expertise over concerns about bias.
  3. Acknowledge that the selection of evidence, voting panel members, and various committees should reflect Canada’s diverse populations.
  4. Follow population outcomes. Rank guideline quality based on safety and patient outcomes above all. Methodology is important and fundamental, but it is not the sole arbiter of quality.
  5. Ensure full transparency in publicly funded science, conducted without non-disclosure agreements (NDAs). Audit panel members’ satisfaction with the process.
  6. Identify the true costs of screening by not simply including the expenses and resource constraints, but also identifying downstream cost savings in calculations. This should include the patient/family costs of disability related to later stage diagnosis. Avoid manipulating science to facilitate budgetary considerations.

Urgently remedy existing guidelines.

  1. Suspend all Canadian Task Force on Preventive Health Care guidelines deemed inappropriate by experts. Replace them, at least on an interim basis, with expert-recommended guidelines, such as USPSTF, NCCN, Canadian and/or American specialty society guidelines.
  2. Have content experts lead the guidelines in their own fields, with methodologists playing an important supporting role. Specialty societies should approve guidelines to avoid confusing and conflicting guidance.
  3. Knowledge translation tools should be designed to be neutral, not biased. Both relative and absolute harms and benefits should be expressed as well as risks of screening and not screening.
  4. Revise guidelines regularly and promptly, particularly when there are new important studies available. Content experts should alert the guideline body when there are important breakthroughs that necessitate updates.
  5. Include disclosure of complementary or contradictory recommendations from other relevant guideline sources to ensure readers are aware of any controversies in the subject matter.

Reform the Task Force.

  1. Restructure the Task Force with a robust governance and accountability structure.
  2. Outcomes should be monitored and any deteriorating outcomes should be quickly addressed. Content experts should lead the calls to action.
  3. Involve ethicists in both the restructuring of the Task Force as well as the choice of topics, development of individual guidelines and outcomes measures. Among other ethical practices, the Precautionary Principle should be a foremost consideration in guideline development.
  4. Involve patient partners at every level. Provide adequate training and support for patients.
  5. Require full disclosure of the credentials of all panel members in all documentation, including the final published guidelines.
  6. Modernize methodology using updated concepts, such as EBM+.