5.2.6.4.2 Explanation of policy statements/consensus guidelines tool

To assess a policy or guideline that seeks to direct action, it is important to be aware of who was involved in its development. Ask:

– Are the authors clearly identified (Including their name, their role/experience/qualifications?).

– Are any allegiances or affiliations with specific organisations or groups known?

Determining whether the developers are informed or possess knowledge about a specific subject is a key stage in assessing the credibility of a policy or guideline. Ask:

– For health professionals or health researchers, what are their qualifications, current role and other indicators such as fellowships or licensures? (Reviewers may wish to follow up the standing of the source by consulting with experts in the field of expertise; checking accreditation rolls; or contacting the source for further information.)

– For patients/consumers/advocates, what are their experiences and role?

Guideline and policy development requires involvement of (or at least consultation with) both health care providers who will be expected to implement them and the receivers of healthcare (patients/clients/consumers). Ask:

– Who are the central stakeholders that might be impacted by this policy/guideline?

– Are these stakeholders either part of the development group; or is there evidence that they have been consulted?

All policy/guideline development groups are likely to include competing interests and to be subject to a range of biases. The quality of the development process is improved if competing interests and potential biases are identified and addressed. Ask:

– Are potential competing interests identified in the policy/guideline document?

– Are potential biases identified in the policy/guideline document?

– Are any strategies to acknowledge and address competing interests and biases presented in the policy/guideline document?

Some policy/guideline developers search for and use published evidence reviews (systematic reviews etc.), published and unpublished papers; and local clinical and activity data. Others commission a full evidence review. For our purpose, it is important to assess the quality of gathering and summarizing data. Ask:

– Are the processes involved in gathering and analysing extant evidence detailed?

– Are the approaches taken rigorous?

Whilst policy/guideline developers may search for and refer to synthesized evidence and because of possible competing interests and local biases, the external evidence may not concur with the conclusions or recommendations embodied in the resulting policy or guideline. Ask:

– Is there any incongruence between the conclusions/recommendations and the extant literature?

– If there is, is this acknowledged in the paper/document?

– Is there a logical defence of any position taken that is in conflict with the extant literature?

Policy and guideline developers usually spend a great deal of time and exert much effort on developing final conclusions or recommendations and seek to balance the evidence with the expertise of the development group and the views of other stakeholders (frequently seeking a consensus view). Thus, a description of how recommendations or conclusions are developed is of importance. Ask:

– Is the process of developing recommendations or conclusions documented?

– Do these processes suggest that a balance between opinion and evidence was sought?