Page 148 - Shared Guideline Development Experiences in Fertility Care

Chapter 7
Guideline development approaches
As highlighted in Box 1, CPG development has been rapidly evolving over the past 10 years. Despite of all e orts that have been made, the appraised quality of the guidelines and the development methods still vary or do not meet the basic quality criteria, including the involvement of patients [2,5–9]. Furthermore, patients are not in the centre of the guideline development process, which may hinder further improvement of the quality of care, which is one of the key goals of CPGs. Finally, several reported problems still hinder CPG development and uptake, namely inadequate management of con icts of interest (COIs), limited panel composition, lack of patient involvement, and lack of external review [6]. ese problems also seem to play a crucial role in the implementability of the CPGs.
One may conclude that healthcare is still fragmented. is conclusion is illustrated by a strong focus on the single clinical aspects of diseases issued in the guidelines rather than on ensuring more integrated care for patients, including attention to matters such as patient-centredness, coordination, and continuity of care. ese problems are not speci c for guideline development and also play a crucial role in the e orts to improve the healthcare system worldwide. Di erent international published perspectives on re-designing healthcare have put forward these arguments and have strived for integrated and patient-centred care [21–28]. If well implemented, CPGs could be the ultimate tools to achieve this shi in healthcare, although essential elements in the approach are still lacking. erefore, the target users feel no a nity with the guidelines, which impedes full implementation. Extensive collaboration among stakeholders seems to be a determining factor in bringing the quality of care to a higher level. Monodisciplinary guidelines, or separate multidisciplinary guidelines on the same topic, may not help policymakers, professionals, or patients to strive for integrated and patient-centred care. Solutions may be found in clustering the guideline development, such as clustering care in terms of integrated care and organizing the care with the patient in the centre. e use of such clinical networks has previously proven to be e ective in increasing evidence-based practice and improving care models [29,30]. erefore, the speci c aim of the study described in Chapter 2 was to assess the feasibility of a patient-centred network approach to guideline development in fertility care. e network approach provides a feasible format for guideline developers to bring patients and other relevant stakeholders together. e e ciency of this approach would bene t from a rigid structure and a supportive organization. Additionally,
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