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USING NATIONAL GUIDELINES FOR
SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS
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.
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
USING NATIONAL GUIDELINES FOR
SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS
What are the purpose of
guidelines?
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“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
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
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
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Medicine is dynamic-New therapies,
technology, etc.
Medical/legal reasons
Optimization of medical resources
Requirement for accreditation
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
USING NATIONAL GUIDELINES FOR
SCREENING, TREATMENT, AND FOLLOW-UP
PATIENTS
WhyOF
areCANCER
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”
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
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
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.
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
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
USING NATIONAL GUIDELINES FOR
SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS
HOW ARE GUIDELINES DEVELOPED?
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.
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?
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?
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?
USING NATIONAL GUIDELINES FOR
SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS
AVAILABLE RESOURCES
•ASCO GUIDELINES (http://www.asco.org)
•NCCN GUIDELINES (http://www.nccn.org)
•NCI GUIDELINES
(http://cancernet.nci.nih.gov/cancertopics/pdq)
•National Guidelines Clearinghouse
(http://www.guideline.gov/)
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
NCCN GUIDELINES
USING NATIONAL GUIDELINES FOR
SCREENING, TREATMENT, AND FOLLOW-UP
OF CANCER PATIENTS
ASCO GUIDELINES
ASCO GUIDELINES
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.