The Guidelines for Guidelines Handbook is designed to help guideline developers produce high quality guidelines that meet the NHMRC Standards for Guidelines
What is a guideline?
Guidelines advise people on how something could be done or what course of action can be taken in a particular circumstance.
The Oxford English Dictionary defines a guideline as a ‘general rule, principle, or piece of advice.’ By definition they are not mandatory, but instead they advise people on how something could be done or what course of action can be taken in a particular circumstance. In the context of healthcare, the former Institute of Medicine defined guidelines as 'statements that include recommendations intended to optimise patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options' (IOM 2011).
High quality guidelines are based on systematic reviews of evidence, transparent development processes and decision making, and the judgement of evidence by experts, consumers and other end users.
NHMRC and guidelines
NHMRC has a long history of developing guidelines and supporting others to do so.
Guidelines developed by NHMRC are termed ‘issued’ guidelines under the National Health and Medical Research Council Act (1992). They cover issues that broadly impact on the Australian population such as the Australian Dietary Guidelines and the Australian Drinking Water Guidelines.
National guidelines developed by groups that are independent of the NHMRC and that meet the NHMRC guideline development standards may be approved by the NHMRC CEO. These are known as NHMRC ‘approved’ guidelines. In order to be approved guidelines must be of high quality, be based on the best available scientific evidence and be developed according to rigorous standards.
NHMRC also plays a role in monitoring guideline activity in Australia through the Clinical Practice Guidelines Portal. Developed as a service for the Australian clinical community, the portal serves as a single access point for Australian clinical practice guidelines.
NHMRC Standards for guidelines
The NHMRC Standards for Externally Developed Guidelines were first published in 1999 as an appendix to A guide to the development, implementation and evaluation of clinical practice guidelines. Later in 2007 the NHMRC standards and procedures for externally developed guidelines was published. Based on the 1999 Standards, its purpose was to inform third party guideline developers of the requirements needed to obtain NHMRC approval.
In 2014 NHMRC established its Synthesis and Translation of Research Evidence (SToRE) advisory group. It was first tasked with reviewing and updating these standards to ensure they aligned with current international best practice. The resulting 2016 NHMRC Standards for Guidelines are applicable to all guidelines containing recommendations for clinical practice, public and environmental health.
‘Guidelines for Guidelines’ Handbook
The Guidelines for Guidelines Handbook is designed to help guideline developers produce high quality guidelines that meet the 2016 NHMRC Standards for Guidelines. It covers all stages of guideline development and is equally relevant to clinical, public and environmental health guidelines.
SToRE has overseen the development of the Handbook with input from Australian guideline developers, methods experts, funders of guidelines, NHMRC Principal Committees and content experts. The Handbook is available through the NHMRC website and will be updated as required when new evidence becomes available. It is expected that the first version of the Handbook will be completed in 2019 when the constituent modules have been written and submitted for public consultation. Modules or chapters will be published under the ISBN 978-1-86496-024-2. Each page lists the appropriate citation of the chapter and acknowledges those who were directly involved in the chapter's development.
The Handbook replaces NHMRC's A guide to the development, implementation and evaluation of clinical practice guidelines, all associated handbooks, and the NHMRC additional levels of evidence and grades for recommendations for developers of guidelines (2009).
NHMRC would like to thank current and former members of SToRE who have worked tirelessly to bring the Handbook to life: Philip Alderson, Lisa Bero, Wendy Chaboyer, Catherine Chamberlain, Dianne O'Connell, Jonathan Craig, Davina Ghersi, Paul Glasziou, Leena Gupta, Mark Lawrence, Philippa Middleton, Zachary Munn, Sally Green, Malcolm Sim, Elizabeth Waters.
The content of the Handbook has been informed by the input of hundreds of people including guideline developers, guideline users, consumers and funders through workshops, public consultation and direct contact with the NHMRC. In particular, NHMRC would like to thank the following people for their contributions: Rebecca Armstrong, Miyoung Choi, Miranda Cumpston, Brigid Gillespie, Quinn Grundy, Lukman Thalib.
NHMRC would like to thank participants of the following workshops who helped scope the ideas in this Handbook.
- NHMRC Guideline Reform Methods workshop: 14 April 2016
- Guideline Developers Meeting: 29 June 2016
- Making Your Guideline Implementable workshop: 17 March 2017
- Making Evidence-Based Recommendations in Public and Environmental Health: 17 April 2018
In 2016 NHMRC released a discussion paper titled Better informed health care through better clinical guidelines, which highlighted the key challenges facing guideline development in Australia. Part of this discussion paper included the draft Standards for Guidelines. Many of the responses were used to prioritise the scope and structure of Guidelines for Guidelines.