CHEST Guidelines are based on a rigorous methodology, striving to meet the highest standards in guideline development, as outlined by the Institute of Medicine (IOM). Guideline panels are carefully selected, screened for conflicts of interest, and include clinical experts who provide their expertise to the interpretation of the evidence and development of the recommendations. Because of the recognized need for credible clinical guidance in topic areas where there is no or weak supporting evidence for a formal guideline, the methodology accommodates to the complete evidence-continuum, from the highest level of supporting evidence (guidelines) to the lowest level of supporting evidence (consensus statements), with the hybrid approach in between using a combination of both processes.
Living Guidelines Model
CHEST currently implements a "Living Guidelines Model" in the creation of its clinical practice guidelines. A living guideline is a systematically developed, evidence-based, and continually updated series of recommendations for the diagnosis and management of medical conditions. Living guidelines are intended to inform both health-care providers and patients in making educated clinical decisions. For more information on the living guidelines model, please read this brief question and answer session with Dr. Richard Irwin, Editor in Chief of the CHEST Journal.
Producing trustworthy clinical practice guidelines involves a rigorous evidence-based approach to identifying and synthesizing the literature that forms the evidence base for the guideline recommendations. The evidence that informs the recommendations is collected through a rigorous systematic review of key questions formulated through the PICO (Patient / Intervention / Comparator / Outcome) development process. All studies included in a body of evidence are assessed for their quality using the GRADE approach.
Consensus Statement Methodology
CHEST recognizes there are times when the lack of sufficient evidence to inform evidence-based recommendations necessitates the development of consensus-based guidance provided by top experts in the field. To address this need, CHEST has developed a process for developing consensus statements using the same rigorous, systematic approach for gathering the evidence base that is used in the development of trustworthy guidelines. Therefore, the opinions expressed in our consensus statements are derived from a systematic approach and a traditional literature review where randomized controlled trials and high-quality evidence do not commonly exist. Suggestions made in consensus statements are derived by this standardized process, and consensus around the suggestions is achieved using a modified Delphi approach. The panelists are carefully screened for conflicts of interest.
An extension of the consensus statement development process is a hybrid approach, which allows us to develop a collection of both evidence-based guidelines and consensus statements for topics where there is enough evidence to inform recommendations in one clinical area but where there is insufficient evidence for another clinical area.
Conflict of Interest Policy
To produce high quality, unbiased guidelines and consensus statements, CHEST routinely reviews, monitors, and manages real or perceived COI for all guideline panelists and reviewers. This policy ensures high-quality, evidence-based, nonbiased guideline recommendations and protects our integrity, as well as the integrity of the guidelines and panelists. (download our new policy)