A new method of analysis enabled a better understanding of clinical practice guideline development processes.
OBJECTIVE
To describe the process by which various forms of evidence are discussed, valued, and interpreted within the process of developing evidence-based clinical practice guidelines and, in so doing, to develop a method for such studies.


METHODS
An observational study. Two guideline development groups were observed by a nonparticipant observer. The 21 meetings were recorded, transcribed, and analyzed using grounded theory and frame analysis. Qualitative analysis was complemented with descriptive statistics.


RESULTS
The groups organized their discussion around four domains--'science', 'practice', politics', and 'process'--and used boundary work to mediate between these domains. Both groups spent most time discussing 'science', followed by 'practice' or its relation with 'science'.


CONCLUSIONS
Our analysis offers an innovative, replicable method of analysis of guideline development that permits the identification of the proportions and interrelations between knowledge domains deployed by guideline groups. This analysis also suggests that the participation hierarchy observed here and by others might be an effect of the imbalanced use of knowledge domains in the construction of clinical guidance. This constitutes an important framework to understand the interplay of participants and knowledge in guideline development.
Moreira
Tiago
T
Centre for Health Services Research, School of Population and Health Sciences, University of Newcastle upon Tyne, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK.
May
Carl
C
Mason
James
J
Eccles
Martin
M
D003627:Data Interpretation, Statistical; D019317:Evidence-Based Medicine; D006126:Group Processes; D006801:Humans; D017410:Practice Guidelines as Topic; D006113:United Kingdom