Organization and guideline development

April 2010

ACCCThe Netherlands

Content

•Organization ACCC

•Guideline development cyclePatient involvement

Grading recommendations

Implementation

Oncoline

Comprehensive cancer center (CCC)

•8 comprehensive Cancer Centres

Comprehensive cancer center (CCC)

•GoalTo provide cancer patients and their families access to comprehensive and high-quality care as close to home as possible.

•Organisation–All hospitals, radiological centres and pathology

labs are affiliated to one particular centre. –Each CCC is associated with five to twenty

hospitals.

Association of comprehensive cancer Centers (ACCC)

(VIKC=ACCC)

Association of Comprehensive Cancer Centres (ACCC)Nationally, CCC work together within the ACCC

National programmes are•Guidelines for diagnosis, treatment and care•The Netherlands Cancer Registry•Organisation and quality of oncological care•Palliative care •Other

Rehabilitation

Evaluation of screening activities

Support of clinical trials

Education and information

National Cancer Control Programme

The ACCC fulfills nationally a coordinating functionin oncological and palliative care.

Guideline development in 7 steps

Step 1 Choice of topic and scopeResult = Relevant and clearly defined key questions, generated

from a representative multidisciplinary analysis of problem areas

• multidisciplinary survey of problem areas is sent to all professionals in relevant fields to identify problem areas

– Is first component of implementation

• A patient version of the survey is sent to patient organisations

Step 2 Preparation

Results•A working group composing necessary

expertise and with sufficient endorsement from relevant scientific, professional, and patient organisations (mandated)

•Ensuring that qualitatively adequate and affordable methodological support is available

•A clear, concise, and complete project plan•Formulated key clinical questions

Step 3 Development of draft CPG

•Literature search•Selecting the evidence•Critical appraisal•Synthesising the evidence

–Data extraction, evidence tables in English, level of evidence

-> Using CoCanCPG formats

•Writing draft text: oncoline format

Grading of recommendations

•Recommendations are formulated on the basis of evidence based conclusions and other considerations

•GRADE is currently not used•ACCC started with project ‘grading of

recommendations in CPG’s’–Literature search of existing grading methods

–Development of a method for grading of recommendations in CPG’s

–Accent on evidence-based conclusion, patient and professional

preferences, safety and cost effectiveness

–The developed method will be pilot tested in the CPG renal cell

carcinoma

–After evaluation it might be refined and used in other CPGs

Step 4 Consultation

Result = Definitive guideline text

• Submitting draft guideline for review to relevant

– scientific societies

– professional societies

– patient organisations

– national tumour working groups

Step 5 Authorisation

•Result = an authorised multidisciplinary evidence-based guideline

•Written request to authorise the guideline sent to the directors of relevant –scientific societies

–professional societies

–patient organisations

–national tumour working groups

Step 6

dissemination and implementation•Guideline available on Oncoline•E-mailing to

-Professional and scientific societies

-National and regional tumour working groups

-Personalized email alert to guideline users / professionals

•Publishing a news report on-Oncoline/Pallialine

-iKCNet (the website of the ACCC)

-Websites of professional and scientific societies

•Publication in journals / scientific magazines–e.g. Dutch Journal of Medicine (NTvG), Oncologica

•Summary cards•Translation of guideline in English

Step 6 dissemination and implementationHow do we implement guidelines?

I During the development of the guideline using the network

II Oncoline and Pallialine, the websites for guidelines of oncological and palliative care

III Activities of the CCC’s and

implementation projects

Implementation1

Guideline implementation during

development•Participation of scientific, professional and

patient societies•National tumor working group•Regional tumor groups via the CCC’s

Step 1: analysis of problem area’s to create clinical questionsStep 2: recruiting experts to participate in the guideline Step 3: informing about the methodStep 4: sending a first draft for feedbackStep 5: sending a second draft for approval

Implementation2 Oncoline

Implementation2 Oncoline

Implementation3

Activities of the CCC’s

CCC’s organise educational tools to implement guidelines

•Consultancy services•Symposia•Meetings•Courses for oncology care providers•Webcasts with accreditation points•Break-through projects

Implementation3

Consultancy services

•Oncologists from oncological centres•Advice medical specialists on actual

guidelines•Take part in oncology meetings in hospitals •Offer mentor-surgery, workshops and video-

conferencing. •Furthermore: nurses, paramedics,

psychosocial, epidemiological and palliative care consultants

Implementation3

Breakthrough projects

•Changes in actual care are implemented in hospitals based on the CPG

•Teams in different hospitals are monitoring their achievements

•Working conferences: results/experiences are presented and compared

•Team of experts help hospitals to improve• 2 projects:

–Mamma carcinoma

–Non-small cell long carcinoma

Guideline development in 7 steps

Step 7 Evaluation, updating and revision1

•Evaluation using indicators for the most important recommendations

•Prospective documentation projects in at least 2 CCC’s using the Netherlands Cancer Registry

•The ACCC is involved in the development and maintenance of indicators in cancer CPG’s initiated by the Dutch government

• Conditions for revision and literature monitoring are established in the guideline.

• These are monitored by the national working group or another committee mandated by the guideline working group.

• The guideline duration of validity (maximum 5 years after approval) is monitored by the ACCC programme office.

-> Cycle starts again

Step 7 Evaluation, updating and revision2

Questions?