ABC1 - A. Cervantes - An introduction to ESMO guidelines

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ABC1 - A. Cervantes - An introduction to ESMO guidelines

  1. 1. An introduction to ESMO GUIDELINES ABC1 CONSENSUS CONFERENCE ANDRES CERVANTES CHAIR, ESMO GUIDELINES WORKING GROUP Lisbon , November 26, 2011
  2. 2. Premise for CPG development <ul><li>ALL membership-based medical societies should produce Clinical Practice Guidelines (CPG) for their members. </li></ul><ul><li>Guidelines should define best clinical practice. </li></ul><ul><li>Adherence to evidence-based CPGs improves patient outcomes. </li></ul>
  3. 3. WHAT ARE CLINICAL PRACTICE GUIDELINES ? <ul><li>Systemically developed evidence-based statements aiming : </li></ul><ul><li>To assist practitioners in appropriate clinical decision-making (best clinical practice) </li></ul><ul><li>To improve quality of healthcare and outcomes for patients </li></ul><ul><li>To influence national policies for efficient allocation of resources and for better delivery systems. </li></ul>
  4. 4. PROVIDE THE RIGHT CARE, AT THE RICHT TIME , FOR THE RIGHT PERSON IN THE RIGHT WAY JAMA 2000, 284:2100-07
  5. 5. History & Evolution of ESMO Guidelines <ul><li>ESMO first began to work on the development of guidelines in 1999 in order to help define the minimum standards of medical oncology practice for Eastern European countries. </li></ul><ul><li>From 2001-2005 the ESMO Minimum Clinical Recommendations were published. </li></ul><ul><li>In 2006 ESMO started to produce the ESMO Clinical Recommendations addressing a wider audience. </li></ul><ul><li>In 2007 the Consensus Conference derived guidelines were established. </li></ul><ul><li>Since 2010 they are called ESMO Clinical Practice Guidelines </li></ul>
  6. 6. THE STRUCTURE OF THE ESMO GLWG E d i t o r i a l B o a r d Chairman & Co -Chairman 2 Members 1 Ann. Oncology Executive 1 ESMO Officer A u t h o r s (Multidisciplinary) R e v i e w e r s 5 ESMO Faculty Members per Topic on a multidisciplinary platform S u b j e c t E d i t o r s 1. Breast Cancer 2. Gynaecological Cancer 3. Haematological Malignancies 4. Head/Neck and Lung Cancer 5. Urogenital Cancer 6. Upper and lower GI tract cancers 7. Pancreato-hepatobiliary cancers 8. Sarcomas 9. Supportive Care 10. Rare Tumours
  7. 7. WHAT KIND OF GUIDELINES ? THE SHORT SIZE GLs <ul><ul><li>Number of pages: 5 (2-13) (Pocket type version) </li></ul></ul><ul><ul><li>Evidence based </li></ul></ul><ul><ul><li>Disease or topic oriented </li></ul></ul><ul><ul><li>Available at ESMO Website </li></ul></ul><ul><ul><li>Only those required update are published in Annals of Oncology </li></ul></ul>
  8. 8. WHAT KIND OF GUIDELINES ? CONSENSUS CONFERENCE DERIVED GLs <ul><li>To address pre-selected questions to 30-40 multidisciplinary experts on specific tumour types </li></ul><ul><li>1 -2 days meeting </li></ul><ul><li>Funded by ESMO or other professional networks </li></ul><ul><li>Update every 2-5 years </li></ul><ul><li>Published in Annals of Oncology </li></ul>
  9. 9. CGC Structure
  10. 10. Basic Methodology: Pre-conference <ul><li>Working Group (WG) responsibilities : </li></ul><ul><ul><li>Identification of available evidence via a narrative review of the evidence. The WG Coordinators will decide how the group will work and may assign specific tasks to each WG member. </li></ul></ul><ul><ul><li>Study of relevant evidence (e.g. assign Questions to WG members who perform narrative review of the evidence). </li></ul></ul><ul><ul><li>Writing up of a report on the Questions & evidence review including a list of important references. </li></ul></ul><ul><ul><li>Forwarding of report to Chairs prior to the Consensus Conference. </li></ul></ul>
  11. 11. Basic Methodology: Conference <ul><li>The Chairs are responsible for and have authority over the conference. </li></ul><ul><li>Suggested general outline (2 day conference): </li></ul><ul><ul><li>INTRODUCTION with all participants. </li></ul></ul><ul><ul><li>WG DISCUSSION PHASE : Each WG to convene and discuss the subtopic. </li></ul></ul><ul><ul><li>JOINT PRESENTATION PHASE : All members meet for presentation of all WG SoERs, to be critically analyzed & discussed by all. </li></ul></ul><ul><ul><li>CONCLUSION PHASE : The CC Chairs conclude what has been discussed, agreed upon or disagreed. </li></ul></ul><ul><ul><li>SUMMARY & PLANNING MEETING: The CC Chairs and WG Chairs may spend some additional time at the end of the conference to discuss decisions and next steps. </li></ul></ul><ul><li>It is advisable to record areas of dissent. </li></ul><ul><li>Following the Consensus Conference, all WGs should send their draft subtopic manuscripts (with Questions, Recommendations and Levels of Evidence) to the Chairs within 1 month. </li></ul>
  12. 12. Basic Methodology: Post-Conference <ul><li>Chairs incorporate all draft subtopic manuscripts (with Questions, Recommendations and Levels of Evidence) in a pre-final manuscript. </li></ul><ul><li>Areas of controversy and dissent are included and acknowledged in the final text. Levels of Evidence and references are provided for every formulated recommendation throughout the document. The grading system must be consistent across guidelines and the basis for the class of recommendation & levels of evidence documented. </li></ul><ul><li>The pre-final manuscript is circulated to all members of the CC for a final check and comments/suggestions. The Chairs finalize the document and forward it to the GLWG and EDC-SC for approval. </li></ul>
  13. 13. CGC Flowchart
  14. 14. DISSEMINATION AND PROMOTION OF ESMO CLINICAL PRACTICE GUIDELINES
  15. 15. <ul><li>AVAILABLE IN AN ANNUAL SUPPLEMENT OF ANNALS OF ONCOLOGY AND ON ESMO WEBSITE </li></ul>
  16. 16. 2. TRANSLATED TO 13 LANGUAGES Bulgarian Chinese French German Polish Portuguese Romanian Russian Spanish Greek Italian Japanese Latvian
  17. 17. 3. ORGANIZATION OF ESMO INTERACTIVE GUIDELINES SESSIONS <ul><li>Guidelines Interactive Sessions have been held during each ESMO Congress since 2002. </li></ul><ul><li>The audience has increased over time up to 3200 attendees in 2010. For the 36 th ESMO Congress in 2012 the GLWG will request two Guidelines Interactive Sessions. </li></ul><ul><li>The audience feedback is positive: </li></ul><ul><ul><li>>60% of the audience had consulted the ESMO CPGs in the past year </li></ul></ul><ul><ul><li>79% thought the ESMO Guidelines are a helpful source of advice </li></ul></ul><ul><ul><li>77% thought the ESMO Guidelines are good educational tools </li></ul></ul>
  18. 18. Total Usage During the First 6 Months Post-Publication (2009-2010)
  19. 19. Geographical breakdown of usage by continent ( 2008 – 2010)
  20. 20. Universal Geographical Breakdown of Usage (2008-2010)
  21. 21. Current & future developments <ul><li>Abridged versions: clinical decision-making support </li></ul><ul><ul><li>Pocket-sized booklets: </li></ul></ul><ul><ul><ul><li>Presenting the key information from CPG/Consensus manuscripts in a quick-reference format </li></ul></ul></ul><ul><ul><ul><li>Including treatment algorithms & all recommendations </li></ul></ul></ul><ul><ul><li>Mobile Apps </li></ul></ul><ul><ul><ul><li>Presenting the information use in the pocket versions in SmartPhone & other App formats for use on mobile devices </li></ul></ul></ul><ul><li>CPG slide-sets: </li></ul><ul><ul><li>For use by ESMO members as a teaching resource. </li></ul></ul><ul><ul><li>To be made available within OncologyPRO. </li></ul></ul>
  22. 22. T h a n k y o u

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