Clinical practice guidelines endeavour to synthesize the highest quality evidence available to recommend best practices that will achieve optimal patient outcomes. Locating guidelines differs from finding typical journal articles because guidelines are not always published in journals, thus they are not necessarily indexed in databases such as Medline. Instead they may form part of the “grey literature” – non-indexed materials stored on websites or printed as ad hoc documents. Guideline databases are time savers because they pull together guidelines from disparate grey literature sources.
The following are excellent sources of guidelines and are listed on the practice guidelines page on the College website:
- Local sources: BC Guidelines, BC Cancer Agency Cancer Management Guidelines
- Canadian guidelines: CMA CPG Infobase. These guidelines are created by Canadian associations, societies, government bodies, etc. (not individual people). Each is created or revised in the last five years.
- American and international guidelines: National Guideline Clearinghouse. An inclusion criteria set provides a minimum quality standard for listed guidelines.
High-quality guidelines provide explicit statements on levels of evidence that support guideline recommendations. Readers should note whether the strength of recommendations accounts for the validity of evidence (i.e. low quality anecdotal reports or high quality systematic reviews, randomized controlled trials or cohort studies). Other factors influence the direction and strength of recommendations such as balance of harm and benefit, feasibility, and value to stakeholders, including patients. As a quality indicator, look for statements where internationally recognized tools such as Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used in developing guidelines’ recommendations.