Guidance in an uncertain world

Moppett, Iain K.; Gardiner, Dale; Harvey, Daniel J. R.

Abstract

In the face of the coronavirus pandemic, clinicians are looking to multiple sources for guidance. Good guidance provides a helpful tool to support decision making by experienced and highly-trained healthcare professionals. However, in the context of a readily changing landscape there are risks of guidance that hinders rather than helps, duplicates effort and fails to consider the front-line implications. Conversely, an overly conservative approach may result in good guidance never seeing the light of day, or being published too late. We suggest that there are key principles that may help guideline producers to improve the process. These include: addressing directly and transparently the competing risks and benefits to individual patients, staff and the wider community; making greater efforts to find reliable data to inform recommendations; ensuring duplication of effort and conflict with extant guidance is minimised; involving front-line staff in development and consideration of real-world implications of delivery; and ensuring that feedback and revisions are integral to the process. The MORAL Balance framework has previously been advocated for making complex individual patient level decision in critical care. We believe the same process can be appliedas a framework for guideline development groups.

Citation

Moppett, I. K., Gardiner, D., & Harvey, D. J. R. (2020). Guidance in an uncertain world. British Journal of Anaesthesia, 125(1), 7-9. https://doi.org/10.1016/j.bja.2020.04.003

• Journal Article Type: Editorial
• Acceptance Date: Apr 1, 2020
• Online Publication Date: Apr 13, 2020
• Publication Date: Jul 1, 2020
• Deposit Date: Apr 17, 2020
• Publicly Available Date: Apr 14, 2021
• Journal: British Journal of Anaesthesia
• Print ISSN: 0007-0912
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 125
• Issue: 1
• Pages: 7-9
• DOI: https://doi.org/10.1016/j.bja.2020.04.003
• Keywords: Clinical guidelines; COVID-19; Coronavirus
• Public URL: https://nottingham-repository.worktribe.com/output/4299851
• Publisher URL: https://bjanaesthesia.org/article/S0007-0912(20)30213-0/fulltext