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Ponce OJ, Alvarez-Villalobos N, Shah R, Mohammed K, Morgan RL, Sultan S, Falck-Ytter Y, Prokop LJ, Dahm P, Mustafa RA, Murad MH. What does expert opinion in guidelines mean? a meta-epidemiological study. ACTA ACUST UNITED AC 2017; 22:164-169. [PMID: 28924055 DOI: 10.1136/ebmed-2017-110798] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/03/2022]
Abstract
Guidelines often use the term expert opinion (EO) to qualify recommendations. We sought to identify the rationale and evidence type in EO recommendations. We searched multiple databases and websites for contemporary guidelines published in the last decade that used the term EO. We identified 1106 references, of which 69 guidelines were included (2390 recommendations, of which 907 were qualified as EO). A rationale for using EO designation was not provided in most (91%) recommendations. The most commonly cited evidence type was extrapolated from studies that did not answer guideline question (40% from randomised trials, 38% from observational studies and 2% from case reports or series). Evidence extrapolated from populations that were different from those addressed in the guideline was found in 2.5% of EO recommendations. We judged 5.6% of EO recommendations as ones that could have been potentially labelled as good practice statements. None of the EO recommendations were explicitly described as being solely dependent on the clinical experience of the panel. The use of EO as a level of evidence in guidelines remains common. A rationale for such use is not explicitly provided in most instances. Most of the time, evidence labelled as EO was indirect evidence and occasionally was very low-quality evidence derived from case series. We posit that the explicit description of evidence type, as opposed to using the label EO, may add clarity and transparency and may ultimately improve uptake of recommendations.
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Affiliation(s)
- Oscar J Ponce
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Raj Shah
- Department of Medicine, University of Missouri-Kansas City, Kansas, Missouri, USA
| | - Khaled Mohammed
- Pediatric Residency Program, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Center for Chronic Diseases Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota, USA
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Philipp Dahm
- Department of of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mohammad H Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
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Clinical Guidelines in Asthma and Chronic Obstructive Pulmonary Disease: How Useful Are They in Clinical Practice? Arch Bronconeumol 2017; 54:117-118. [PMID: 28918869 DOI: 10.1016/j.arbres.2017.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/20/2022]
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Thacher TD, Rajkumar SV, Lanier WL. Call for Papers on Clinical Practice Guidelines. Mayo Clin Proc 2017; 92:327-328. [PMID: 28259225 DOI: 10.1016/j.mayocp.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/17/2022]
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