Patient and public involvement in the development of clinical practice guidelines: a scoping review

OBJECTIVES

Organisations that develop clinical practice guidelines (CPGs) encourage involvement of patients and the publics in their development, however, there are no standard methodologies for doing so. To examine how CPGs report patient and public involvement (PPI), we conducted a scoping review of the evidence addressing the following four questions: (1) who are the patients and publics involved in developing the CPG?; (2) from where and how are the patients and publics recruited?; (3) at what stage in the CPG development process are the patients and publics involved? and (4) how do the patients and publics contribute their views? We also extracted data on the use of PPI reporting checklists by the included studies.

DESIGN

We used the methodology developed by Arksey and O'Malley and refined by the Joanna Briggs Institute. We searched PubMed, Embase, CINAHL and PsycINFO, websites of national guideline bodies from the UK, Canada, Australia and the USA, and conducted a forward citation search. No language, date or participant demographics restrictions were applied. Data were synthesised narratively.

RESULTS

We included 47 studies addressing 1 or more of the 4 questions. All included studies reported who the patient and publics involved (PPI members) were, and several studies reported PPI members from different groups. Patients were reported in 43/47 studies, advocates were reported in 22/47 studies, patients and advocates reported in 17/47 studies, and general public reported in 2/47 studies. Thirty-four studies reported from where the patients and publics were recruited, with patient groups being the most common (20/34). Stage of involvement was reported by 42/47 studies, most commonly at question identification (26/42) and draft review (18/42) stages. Forty-two studies reported how the patients contributed, most commonly via group meetings (18/42) or individual interviews. Ten studies cited or used a reporting checklist to report findings.

CONCLUSIONS

Our scoping review has revealed knowledge gaps to inform future research in several ways: replication, terminology and inclusion. First, no standard approach to PPI in CPG development could be inferred from the research. Second, inconsistent terminology to describe patients and publics reduces clarity around which patients and publics have been involved in developing CPGs. Finally, the under-representation of research describing PPI in the development of screening, as opposed to treatment, CPGs warrants further attention.

S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“

Zusammenfassung. Zielsetzung: Alkoholkonsum ist in Deutschland mit erheblichen gesundheitlichen und wirtschaftlichen Folgen assoziiert. Neben der Prävention spielen die Früherkennung und differentielle Behandlung von Betroffenen eine bedeutende Rolle. Die Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“ bildet die Grundlage für die Versorgung betroffener Personen. Die regelmäßigen Updates implementieren evidenzbasiert den aktuellen Forschungsstand von Literatur und klinischer Expertise. Methodik: Unter Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und Suchttherapie e. V. (DG-Sucht) wurde die S3-Leitlinie Alkohol von 2019–2020 in acht Arbeitsgruppen überarbeitet. Am strukturierten Konsensprozess zur Beratung der Empfehlungen beteiligten sich 35 Fachgesellschaften. Potentielle Interessenskonflikte wurden im Vorfeld erfragt, dokumentiert und in der Abstimmung der Empfehlungen berücksichtigt.: Die Leitlinie gibt Empfehlungen zu Screening und Kurzintervention für verschiedene Personengruppen, sowie zur Behandlung von Betroffenen in der akuten und postakuten Phase des Entzugs. Besondere Bedeutung kommt der Behandlung von komorbiden somatischen und psychischen Störungen zu. Außerdem wurden Empfehlungen für bestimmte Personengruppen (z. B. Kinder und Jugendliche, Schwangere) ausgesprochen und auf die deutsche Versorgungslandschaft adapiert.

[Treatment of alcohol-related disorders in children and adolescents: Age-specific treatment recommendations from the new interdisciplinary S3-guideline]

Objective

Alcohol-related disorders typically have an early onset. However, current treatment provisions often fail to address developmental aspects adequately. Recently, the new evidence- and interdisciplinary consensus-based German S3-guideline (National Clinical Practice Guideline) was established for the screening, diagnosis, and treatment of alcohol-related disorders in young patients. For the first time it includes population-specific recommendations.

Method

For this new S3-guideline, 23 source guidelines, 28 systematic reviews, and 2,213 study reports were analyzed. An interdisciplinary consensus conference devised 174 recommendations with 14 specific recommendations for children and adolescents. Depending on the quality of evidence, they issued “must,” “should,” and “can” recommendations or a “clinical consensus point (CCP).“

Results

For the psychotherapeutic treatment of children and adolescents with alcohol-related disorders, a “must” recommendation was devised for motivational interviewing, cognitive behavior therapy, and inclusion of family members in treatment. Recommendations for family-based therapies are heterogeneous. For psychosocial therapies (psychoeducation, parent counseling, ergotherapy, also hospital schools) a CCP was devised. Concerning pharmacological treatment, the evidence base was insufficient; only for treating comorbid disorders (ADHS) could a CCP be derived. As to differential indications, elevated risks for suicide, for treatment dropout, and for delinquency influenced by copatients should be considered (CCP).

Conclusions

Numerous population-specific recommendations have been issued for the treatment of alcohol-related disorders in youths. However, urgent research requirements have been identified especially in medical drug treatment.

Addiction research centres and the nurturing of creativity: IFT Institut für Therapieforschung in Munich, Germany

This paper describes the history and current structure of the Institut für Therapieforschung (IFT) [Institute for Therapy Research] in Munich, as well as major research topics and factors which might contribute to a creative structure and atmosphere for innovative research in the addiction field. The institute was founded in 1973 as a non-profit non-governmental organization (NGO) with a focus on applied research. Starting with behaviour therapy-based development and evaluation of programmes for alcohol, illicit drugs and smoking and the evaluation of treatment services, the institute gradually expanded its topics, covering prevention (1985) and epidemiology and policy evaluation (1990), and participated throughout this period in the development of guidelines and screening, diagnostic and clinical instruments. Later, the IFT tried to bridge the gap between basic sciences, applied research, health-care services and health policy, with a network of national and international contacts, including its own university engagements and collaborations with foreign research groups and national and European Union (EU) agencies. Possible creativity-promoting factors on the institutional and individual levels are discussed, e.g. the collaboration of experienced senior researchers with carefully selected innovative doctoral students, considerable in-house and external training of young researchers and the early participation and presentation of their work at international conferences, independence from stakeholders in the field and the refusal of project funds which require external clearance of publications.