Update of ECCO Guideline SOPs
Glen Doherty, GuiCom Chair
The generation of high-quality practice guidelines remains a key priority for ECCO as an organisation. Arising from an important initiative by the Governing Board, in the last year GuiCom has introduced significant changes in the way that ECCO Guidelines are created. These changes have been introduced to ensure that we are using the best methodology in the creation of our guidelines, in line with international best practice. By adopting this approach, we will ensure that ECCO Guidelines stand up to robust external scrutiny, that they remain objective and evidence based, and that conflicts of interest are not permitted to influence guideline recommendations.
The most significant change has been the adoption of GRADE methodology for the ECCO Treatment Guidelines for Crohn’s Disease and Ulcerative Colitis in adults. GRADE offers a systematic approach to evaluation and rating the certainty of evidence in systematic reviews and other evidence syntheses. GRADE is now the preferred approach of the Cochrane collaboration and many other leading professional societies. In order to familiarise guideline participants with this new approach, we hold a dedicated teleconference to train them in the GRADE process. A ‘kick-off meeting’ for each guideline project is planned to allow formulation of key questions to be addressed in the guideline. These are framed using a PICO question model, addressing a specific patient population, intervention and agreed hierarchy of outcomes. A standardised approach to literature research has now also been introduced and ECCO has contracted the services of a professional librarian to support the searching of abstracts for inclusion in GRADE evaluation. Guideline participants complete evidence tables and, based on these, draft recommendations using standardised terminology. In another important development, these recommendations are framed with and voted upon in the context of the supporting text rather than in isolation (to allow those voting to see the recommendation in the context of the evidence). When agreement is achieved at the final consensus meeting, the manuscript arising is reviewed, in addition, by a medical writer to ensure maximum clarity and comprehension. To allow maximum transparency, a standardised conflict-of-interest statement is completed and published for all ECCO Guideline participants.
To ensure that guideline methodology is employed in a consistent and correct manner, updated standard operating procedures (SOPs) for guidelines which use GRADE methodology have been developed. Some ECCO Guidelines will continue to employ Oxford levels of evidence as a rating system, particularly in areas where the evidence base is poor or for guidelines which look at topics other than disease treatment. Even for these guidelines, the new approach to literature searching and assessment will be utilised and SOPs implemented.
The first ECCO Treatment Guideline using GRADE methodology, the update to the adult Crohn’s Disease treatment guidelines, will be completed this year. The feedback from participants is positive but the new process certainly demands significant effort by all guideline participants. GuiCom recognises that the implementation of this strategy is dependent on the hard work and commitment of all our guideline participant members. Work has already commenced on an update to the adult Ulcerative Colitis treatment guidelines using a similar approach. We are confident that the guidelines arising from these important changes will support best practice and meet the needs of ECCO Members and patients with Inflammatory Bowel Diseases long into the future.