Guideline Development

Guideline Development

CHEST guidelines meet the highest standards in guideline development, as outlined by the National Academy of Medicine (NAM). 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 across topic areas with varying levels of supporting evidence, the methodology accommodates the complete evidence continuum, from the highest level of supporting evidence (clinical practice guidelines) to the lowest level of supporting evidence (expert panel reports).

Conflict of interest policy

CHEST routinely reviews, monitors, and manages real or perceived conflicts of interest (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. View our Guideline COI Policy.

Guideline methodology

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.

Rapid guideline methodology

The development of clinical practice guidelines requires a substantial time commitment, often between 18 and 24 months. However, critical circumstances can necessitate the development of trustworthy recommendations in a much shorter timeframe. In order to produce rapid guidelines while maintaining a standardized, rigorous, and transparent process, CHEST follows the guiding principles set forth by the GIN-McMaster Guideline Development Checklist extension for rapid recommendations.

Expert panel report methodology

CHEST recognizes there may be important clinical questions for which guidance is needed but that have a minimal body of evidence upon which recommendations can be based. To address this need, an expert panel report may be developed, using a rigorous, but pragmatic, approach toward evidence synthesis. Clinical recommendations made in an expert panel report are derived from modified literature reviews and remain grounded by the evidence. Expert consensus for each recommendation is achieved using a modified Delphi approach, with final recommendations considered ungraded consensus-based statements.