Page 75 - Shared Guideline Development Experiences in Fertility Care

advertising posters to all 103 clinics o ering fertility treatments in the Netherlands for their waiting rooms.
Obtaining Recommendations from Wiki Participants
Formulating Recommendations
From May to December 2008, we presented the dra recommendations
for fertility care on the wiki. Patients were invited to modify or re ne these recommendations and to add new recommendations. During this process, we
asked patients to subscribe voluntarily through an email address and to provide background characteristics for study purposes. A er 2 months, when the number
of recommendations started to increase, patients and patients’ representatives
requested us to add 2 sections to the existing structure of the wiki: 1 regarding
the care delivered by the laboratory (e.g., recommendations regarding semen
analysis), and 1 regarding the care delivered by the remaining professionals who 4 were not represented in a separate section (e.g., recommendations regarding the
medical psychologist). Hence, we added 2 sections to the wiki: laboratory and remaining. Next, we recategorized recommendations from the general section regarding care delivered by the laboratory or care delivered by professionals other than the general practitioner, gynaecologist or urologist. A er this restructuring of the wiki, the general section contained only recommendations on fertility care in general, thus not referring to the care delivered by 1 of the professionals involved.
Modifying Recommendations
A er 7 months, we modi ed the recommendations in several steps. First, we removed duplicate recommendations. en, if necessary, we moved recommendations into the appropriate sections (EB, JK). Since all recommendations in the remaining section turned out to be more suited to other sections, we eliminated this section. Next, 2 researchers (EB, WN) and the chief executive of Freya (JK) independently assessed the implementability of all recommendations using the Guideline Implementability Appraisal (GLIA) instrument [30]. Discrepancies were discussed and resolved through consensus. Based on the results of this assessment, the recommendations were independently textually re ned or modi ed by a researcher (EB) and the chief executive of Freya (JK). Finally, a er consensus was reached on the nal formulation, we re-entered the recommendations into the wiki.
Wiki for patient participation
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