FEATURE
friends.” At every level of approval, individuals are likely
to be included who are unfamiliar to the chair and to
each other. The goal is to create a group that is balanced,
diverse, and multidisciplinary.
“We want to include those in academics and practicing community hematologists, methodology experts and
content experts, and even experts from other relevant
fields [such as health economics],” Dr. Rajasekhar said.
“Readers may trust a
guideline on the basis
of a strong development process, but they
also pay attention to
who served on the
panel.”
—ANITA RAJASEKHAR, MD
ASH has also made efforts to include junior faculty members, women, minorities, and international experts to ensure there are diverse backgrounds and ideas represented
on the panel as well.
Research has supported the use of such multidisciplinary teams to create a balanced panel that can ultimately deliver clinically meaningful guidelines, according
to Holger Schünemann, MD, PhD, MSc, chair of the
Department of Clinical Epidemiology and Biostatistics at
McMaster University in Ontario.
Creating Credibility
Another important factor in the selection process is
minimizing potential conflicts of interest – financial or
research-based – or any circumstance that would prevent
a panelist from approaching the question or recommendation with an open mind. “There is a lot of evidence
that indicates that people with potential conflicts make
recommendations that are not necessarily in the best
interests of those who are at the receiving end, so these
conflicts of interests and considerations have started to
play a very important role in eligibility for these panel
positions,” Dr. Schünemann, who is also serving as the
vice-chair of the VTE coordination panel, said.
Guided by an ASH stand-alone policy created to help
manage conflict of interest in guideline development
creation, those who select the panel vet each candidate to
assess any potential conflicts.
“In [ASH’s] particular policy, we mandate that a majority of each guideline panel, including the chair and the
vice chair, cannot have any current financial interest with
companies that could be positively or negatively affected
by the guidelines,” Dr. Rajasekhar said.
This policy is intended to be consistent with recommendations of the Institute of Medicine (IOM) as well as
the Council of Medical Specialty Societies, a membership
organization that represents most U.S. medical specialty
societies including ASH, according to Dr. Panepinto.
“The ways guideline developers think about conflict of
interests has evolved greatly. Not long ago, conflicts were
managed mainly through disclosure and transparency. In
2011, IOM raised the bar by recommending limits on the
participation of individuals with conflicts.”
ASHClinicalNews.org
However, ASH guideline panels aren’t completely free
of conflict of interest by design.
Members who have what’s perceived as a conflict of
interest could also be those who have the most clinical
or research experience in a given area – their expertise
could be a valuable part of the panel. The key, Dr. Rajasekhar said, is preventing bias (not conflict of interest)
from entering into the process. “It is crucial to have that
scientific, clinical, methodologic, or other expertise and
ensure that you are preventing bias from those conflicts,” she said.
Patients can also be a valuable part of the process, as
well. Experts say having patients on guideline panels can
provide the team with a unique and essential perspective.
“The doctors don’t receive the treatment; the patients do,” Dr. Schünemann remarked, “Patients are the
individuals who can probably best consider whatever the
interventions are or what the actual outcomes are that are
being prevented or caused by treatment.”
“The IOM recommends that patient representatives
should be included in the guideline development process,
at a minimum during the question formulation step,” Dr.
Panepinto explained. “We are piloting involving them
on our VTE guidelines.” With the support of patient advocacy organizations, including the National Blood Clot
Alliance, ASH staff identified more than 100 individuals
who personally experienced VTE and were interested
in v