Page 147 - Shared Guideline Development Experiences in Fertility Care

Discussion
Clinical practice guidelines are actually designed to support the decision-making processes in patient care and reduce inappropriate practice variation [2]. Published data con rmed that CPGs can substantially improve daily clinical practice, but low-quality guidelines may harm patients [3,4].
It is therefore not surprising that in the past 10 years the elements of the guideline development process and the quality of the guidelines have been issued and criticized nationally and internationally [2, 5–9]. In 2003 e Appraisal of Guidelines for Research and Evaluation (AGREE) Collaboration issued criteria to assess the quality of guidelines [10]. is collaboration developed a generic instrument to assess the methodological quality of Clinical Practice Guidelines using 23 key items grouped in 6 domains: scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, and editorial independence. Worldwide, this initiative has led to the development of guideline programs and manuals by leading institutes, in which the elements and crucial steps have become a more standardized process; quality assessment according to the items of the AGREE instrument played a major role in the development of this process [11–14]. In 2009 in the Netherlands, ‘the regieraad’ was issued by e Dutch Ministry of Health to overcome major problems in the development, uptake, and quality of guidelines. In 2010, they published the rst version of a general guideline manual, which included minimal quality requirements for guidelines, called guidelines for guidelines. is document was updated twice in 2011 and 2012 [15]. In addition, in 2011 the rst version of ‘medical specialists’ guidelines 2.0’ was published and endorsed by all 32 Dutch Medical Specialty societies [16]. e latter included a broader scope, including the minimal requirements regarding the guideline development process.
e guideline development process generally enhances several elements including topic selection, de nition of the scope, formulation of key questions, answering the key questions by systematically reviewing the relevant literature and assessing its quality, formulation of conclusions and considerations, formulation of recommendations, reviewing the dra guideline (internal and external), and authorization and dissemination by relevant stakeholders. In addition, the ‘medical specialists’ guidelines 2.0’ recommends that an implementation strategy should be conceptualized since guidelines do not implement themselves [3,17,18]. Preferably, the last step should be followed by an evaluation, including the monitoring of the quality of care when applying guideline-based quality indicators [19,20].
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