Establishing a Glocalization Methodology for Developing and Updating Evidence-based Clinical Practice Guidelines: Taiwan experience.
2Cochrane Taiwan, Taipei Medical University, Taiwan
3Department of Public Health, School of Medicine, College of Medicine, Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan & Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
4School of Nursing, College of Nursing, Taipei Medical University; Cochrane Taiwan; Department of Nursing, Wan Fang Hospital; Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
5Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan & Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taiwan
High-quality Clinical Practice Guidelines (CPGs) require rigorous and transparent methodology with updating in time for optimal healthcare decisions. Evidence generation and clinical recommendations formation have been updated with the introduction and evolution of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. Developing a credible method for the glocalization of CPG development is imperative.
Objectives: To establish a glocalization methodology for developing and updating evidence-based CPGs in Taiwan.
Methods: To systematically review internationally developed methodologies for evidence-based CPGs; analyze qualitative data by Delphi methodology, focus group discussion, and expert interview; and propose a tailor-made glocalization methodology for developing and updating CPGs in Taiwan.
Results: A total of eight CPGs development manuals were included in the systematic review. Initially, the research team summarized the four-stage, 27-phase CPG development process. Sixteen external experts were invited to organize the CPG development committee, including government leaders, legislators, society professionals, quality promotion managers, experienced guideline developers, and patient group representatives. The Cronbach α of two rounds of the Delphi consensus was 0.82 and 0.92, respectively. Additionally, we conducted two focus group discussions and four expert interviews to reach a consensus and establish a “Taiwan Clinical Practice Guidelines Development and Update Manual.” Finally, experts adopted the GRADE as the methodology for evidence evaluation and clinical recommendations formation. It was essential to include the opinions of patients and stakeholders in the guideline development process. Considering the feasibility of CPG development, experts identified a four-step (planning, development, publishing, and updating) and 16-phase approach to guideline development, as shown in Figure 1.
Conclusions: This study proposed a tailor-made glocalization methodology for developing and updating CPGs. Following this, the Taiwan Nurses Association established the “Evidence-based Clinical Practice Guidelines for Pain Management” based on the method to verify its methodological rigor and feasibility. We recommend that the government take action to disseminate the methodology of CPG development for promoting the quality of healthcare.
Patient, public and/or healthcare consumer involvement: Patient group representatives were invited to be the key experts in this project and worked with all the experts in developing the methodology.