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How to Develop a Guideline

 

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How is the focus of a guideline topic narrowed and a research question defined?

It is critical that the panel develop research questions that are narrow, specific, and addressable with the assistance of the methodologist. Please refer to the table below as a guide for developing research questions.

The research questions should include:

  • The patient population
  • The control group
  • The exposure or intervention
  • Outcomes
  • Clarification of the inclusion criteria

The following is an example of a research question that is too broad:

  • "Are anti platelet agents effective in preventing vascular events in patients with vascular disease?"

The following are examples of research questions that are more narrow, specific, and addressable:

  • "Is aspirin effective in preventing stroke in patients with TIA/AF/minor stroke?"
  • "In patients presenting for possible diagnosis of lung cancer, what is the reliability of fiber optic bronchoscopy for diagnosing central (endobronchial) lesions, peripheral lesion >2 cm in diameter, and peripheral lesions <2 cm in diameter?"
  • "What is the value (sensitivity and specificity) of echocardiography in the diagnosis of pulmonary hypertension in patients with clinical symptoms of pulmonary hypertension?"
PICO Table
  Patient Population Intervention or Exposure Control Group or comparison Intervention Outcome(s)
Tips* Start by describing a group of similar patients.

Balance precision with brevity.

 Ask, "Which main intervention should be considered?"

Be specific.

 Ask, "Which is the main alternative to compare with the intervention?"

Be specific.

 Ask, "Which can be accomplished?" or "What could this exposure/intervention really affect?"

Be specific.
Example "In patients with heart failure from dilated cardiomyopathy who are in sinus rhythm…?" "…would adding anticoagulation with warfarin to standard heart failure therapy…?" "…when compared with standard therapy alone…?" "…lead to lower mortality or morbidity from thromboembolism. Is this enough to be worth the increased risk of bleeding?"

* Centre for Evidence-Based Medicine
 
 

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