NICE short clinical guideline (SCG) development: An overview of the role of the information specialist

Lynda Ayiku and Hanna Lewin (NICE Information Specialists)

What is NICE?

• The National Institute for Health and Clinical Excellence (NICE) was set up in 1999 and is responsible for

– providing national guidance on the promotion of good health and the prevention and treatment of ill health

– setting quality standards

– managing NHS Evidence

Copyright ©2006 BMJ Publishing Group Ltd.

Minhas, R. BMJ 2006;332:1394

The information services team at NICE

The NICE information services team provides

“professional expertise to enable access to quality information. Their work supports NICE staff, contributes directly to the development of guidance and the work of the Directorates, and facilitates the development of a knowledge-led culture at NICE” (NICE Business plan)

Presentation overview

1. Introduction to NICE clinical guidelines

2. Role of information specialists in the development of NICE short clinical guidelines

3. Collaboration to share knowledge and best practice

NICE clinical guidelines• NICE clinical guidelines are recommendations on the appropriate

treatment and care of people with specific diseases and conditions within the NHS in England and Wales

• Standard clinical guidelines (CGs):– cover the full pathway of care for diseases and conditions– are developed externally by national collaborating centres (NCCs)

that are contracted by NICE

• Short clinical guidelines (SCGs):– cover a specific aspect of the pathway of care for diseases and

conditions – are produced in-house at NICE

• Guideline topics are referred to NICE by the Department of Health

NICE clinical guideline development

Scoping

Development

Validation

Publication and dissemination

Stakeholder consultation

Draft scope

GDG develops guideline

Final scope

Consultation on draft guideline

Revise guideline after comments

Pre-publication check

Prepare and publish guideline

Final guideline published

Stakeholder consultation

NICE short clinical guidelines (SCGs)

• The NICE SCG programme was established in 2006

• SCGs are developed to the same rigorous methods as standard clinical guidelines but they are produced in 11-13 months (instead of 18-24 months)

• They allow the rapid development of guidance on aspects of care for which the NHS requires urgent advice

NICE short clinical guidelines

To date, 7 SCGs have been published on a wide variety of topics:

• CG96 Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings (Mar 2010)

• CG93 Donor breast milk banks: the operation of donor breast milk bank services (Feb 2010)

• CG86 Recognition and assessment of coeliac disease (May 2009)

• CG83 Rehabilitation after critical illness (Mar 2009)

• CG69 Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care (Jul 2008)

• CG64 Antimicrobial prophylaxis against infective endocarditis (Mar 2008)

• CG50 Acutely ill patients in hospital (Jul 2007)

Role of information specialists

• A core team of 5 NICE information specialists (ISs) provide information support for SCGs (led by a senior information specialist)

• They work alongside a multidisciplinary NICE technical team including

technical analysts, health economists, clinical advisers, and medical editors to aid the development of SCGs

• ISs are involved throughout all SCG development stages:

1. Topic selection

2. Scoping

3. Development

Topic selection

• The Department of Health sometimes suggests topics directly to NICE

• Topics for potential guidance are suggested to NICE by organisations such as the National Horizon Scanning Centre (Univ. of Birmingham)

• Topics are also suggested by health professionals, patients, and members of the public – ISs filter topic suggestions to assist with the identification of potential SCG topics

Scoping

• DH Referral

– Department of Health refers SCG topics to NICE. The referred topics are usually broad and non-specific

• Scoping searches

– ISs conduct comprehensive high level scoping searches for guidance documents, economic evaluations, and systematic reviews

– aim to identify gaps in evidence to help focus SCGs on aspects of care where current guidance is insufficient or contradictory

• Scope document

– developed by the technical analysts and health economists based on the findings of the scoping search

– sets out the focus of the SCG topic, lists the proposed guideline review questions, and states inclusion/exclusion criteria

Scoping workshops - working with experts

• Scoping workshops

– a scoping workshop is held during the SCG scoping stage

– health professionals and patient representatives attend the workshops to discuss the proposed SCG scope. The purpose is to ensure that the scope is feasible and relevant for NHS clinical practice

– the technical team amends the scope as required on the basis of the feedback from the meetings

– ISs attend the meetings to gain a greater understanding of the SCG topic to help with the development literature searches

Example of IS role in scoping: CG93 Donor breast milk banks (Feb 2010)

• Original DH remit– To produce a short clinical guideline on the use of human donor

breast milk in preterm babies

• However scoping search results and experts’ feedback highlighted benefits of donor breast milk for full-term as well as pre-term babies

• In addition, scoping searches and expert feedback indicated that comprehensive, high quality guidance was required on delivering donor milk bank services

• As a result of these scoping activities, the remit was broadened and the title was changed to– Donor breast milk banks: the operation of donor breast milk

bank services

Development• Guideline review questions

– each SCG has 4-6 review questions that make up the guideline

– the technical analysts and health economists produce structured questions (PICOs) for each of the review questions

– information specialists use the PICOs to inform the development of literature searches

• Development literature searches

In adherence with the methods detailed in the NICE Guidelines Manual (2009), literature searches are conducted to answer each guideline review question.

This involves:

– determining which sources to search (core databases include Medline, Embase, and the Cochrane Library)

– developing search strategies to search sources effectively and efficiently

– creating and maintaining reference management databases

– documenting the search process

GDG meetings – working with experts

• Guideline Development Group (GDG) meetings

– 4 GDG meetings are held for each SCG topic

– attended by the NICE technical team and recruited external GDG members (clinicians, patient representatives, and other experts)

– GDG members are responsible for developing guideline recommendations based on literature search evidence and expert consensus

– ISs present their literature search methods at GDG meetings and are responsible for answering queries about the searches

IS role in development example: CG 96 Neuropathic pain (March 2010)

• Referred by DH 19th wave August 2008

– Scoping searches conducted October 2008

• Development phase Feb-Oct 2009

– Development literature searches completed April 2009

• Guideline published March 2010

Guideline reviews questions - CG 96 Neuropathic pain (March 2010)

• Full title - Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings

• 4 guideline review questions on the following pharmacological interventions:

– antidepressants

– anti-epileptics

– opioid analgesics

– topical pain preparations

Search example: CG96 Neuropathic pain (March 2010)

1. (neuropathic$ adj3 pain$).tw.

2. Diabetic Neuropathies/

3. (diabet$ adj3 neurop$).tw.

4. Neuralgia, Postherpetic/

5. (postherp$ adj3 neuralg$).tw.

6. Trigeminal Neuralgia/

7. (trigemin$ adj3 neuralg$).tw.

8. (central$ adj3 pain).tw.

9. etc…

10.or/1-9

11.antidepressants search terms

12.anti-epileptics search terms

13.opioid analgesics search terms

14. topical pain preparations search terms

15.or/11-14

16.10 and 15

• A total of 23,207 studies retrieved by the systematic searches

– antidepressants = 2781

– anti-epileptics = 4757

– opioid analgesics = 9612

– topical pain preparations= 6057

• A total of104 studies included in the guideline:

– 90 randomised placebo-controlled trials

– 10 head-to-head comparative trials

– 4 combination therapy trials

Collaboration

• Collaborate with National Collaborating Centre (NCC) information professionals:– best practice is shared and developed between the information

professionals at NICE and the NCCs by a dedicated discussion list and bi-annual meetings

– joint working groups are set up as necessary to take forward specific methodological issues

• Participate in a range of professional interest groups. For example:– Consortium  of Independent Health Information Libraries in

London (CHILL) and Library and Information Health Network North West (LIHNN)

– Health Technology Assessment International (HTAi) and Special Interest Group on Information Resources (SPIG-IR)

– Guidelines International Network (GIN) - SEARCH group

Any questions?

NICE Information Services: InformationServices@nice.org.uk

Lynda Ayiku: lynda.ayiku@nice.org.uk

Hanna Lewin: hanna.lewin@nice.org.uk