Platform Overview
The CRISM network has growing experience in the development of therapeutic guidelines to support diagnosis, prevention, and treatment of substance use disorders with the aim to address implementation gaps that are present in approaches to substance use care. It has published several guidelines and guidance documents. Where resources allow, CRISM will seek to continue supporting the development of therapeutic guidelines to support evidence-based care for various substance use disorders. Many evidence-based approaches remain under-utilized and there remain circumstances that often lack standards for evidence-based best practice.
Documents are developed in collaboration with knowledge translation partners to ensure they reach, and are able to be used by, diverse audiences. CRISM’s Guideline Development Platform seeks to centralize available resources so that, where resources allow, support for various stages and types of activities (i.e., initiation, work plan and overall development, publication, knowledge translation, etc.) are available to network members.
With its previous guideline development experience, the platform is well-positioned to support guideline activities and the connection of experts across the network, for example, to help with developing a guideline committee and suggesting potential members. We also provide guidance on budget development and support the exploration of potential funding opportunities.
CRISM’s approach to guideline development is based upon evidence-based decision making, seeking to incorporate the best available research evidence through an interdisciplinary lens. The network is committed to following best practices in systematic review and guideline development to ensure that this work facilitates shared decision making and addresses gaps in knowledge.
For the Guideline Development Platform, CRISM BC:
- Develops, maintains, and provides resources, including documents and links to existing resources, to support guideline development.
- Builds connections across the network to ensure representation across all nodes for national guideline development and associated activities. This includes, but is not limited to, committee member recommendations (i.e., content experts, clinicians, PWLLE of substance use, policy-makers, etc.) and invitations, committee handbook and work plan development.
- Supports, upon guideline completion, developing strategies around knowledge translation and corresponding activities, etc.
Resources for Developing Guidelines
CRISM follows established standard guideline development tools, outlined below, and these include the ADAPTE framework and use of the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE-II) tool. These tools are used to ensure that guideline design and updates meet international standards for transparency, high quality, and methodological rigour. The work also employs the Grading Recommendation Assessment, Development and Evaluation (GRADE) tool to determine the certainty of the evidence as well as an international framework to manage conflicts of interest.
ADAPTE
The ADAPTE framework is a systematic approach for adapting existing clinical practice guidelines so they are appropriate for use in a different cultural, organizational, or healthcare setting. Rather than developing a new guideline from scratch, ADAPTE provides a structured process for identifying, assessing, selecting, and modifying existing high-quality guidelines while considering the local context, including available resources, priorities, legislation, and healthcare needs. The framework consists of three main phases: set-up, adaptation, and finalization, with the goal of producing guidelines that are both evidence-informed and relevant to the setting in which they will be implemented.
GRADE-ADOLOPMENT
As recommendations are being developed in a guideline, their strength must be rated. The most widely used system is GRADE. GRADE works by assessing the certainty of evidence across key domains (e.g., risk of bias, inconsistency, indirectness, imprecision, and publication bias) and using these judgments to inform the strength of recommendations.GRADE starts with the body of evidence for each outcome, rates its certainty as high, moderate, low, or very low, and candowngrade or upgrade that certainty based on factors such as risk of bias, inconsistency, indirectness, imprecision, and publication bias. GRADE-ADOLOPMENT is an extension of the GRADE approach that provides a structured framework for developing recommendations. Rather than creating recommendations from scratch, it allows guideline developers to adopt existing recommendations, adapt them to a new context, or develop recommendations de novo when needed. This approach ensures the process is more efficient while maintaining transparency and trustworthiness in the recommendations.
AGREE II
AGREE II is a validated tool used to assess the quality and methodological rigor of clinical practice guidelines across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. The instrument assesses guideline quality, provides guidance on designing new guidelines, and clarifies what needs to be included in guidelines for publication.
Guideline International Framework for Conflict of Interest Management
For the development of clinical practice guidelines, there needs to be examination of the existence and disclosure of industry-related organization funding and financial conflicts of interest, and procedures for managing financial conflicts of interest. The principles outlined in the Guidelines International Network: Principles for Disclosure of Interestes and Management of Conflicts in Guidelines support the identification of divergence between authors’ private interests and their professional obligations. Additionally, reporting of financial conflicts of interest in Canadian clincal practice guidelines has been examined and it is clear the importance of oversight on financial conflicts to eliminate industry influence.
Compensation
CRISM members participating in the development of CRISM guidelines are compensated at an hourly rate for all guideline activities (e.g., attending and participating in meetings, reviewing and providing feedback on documents, etc.). Compensation that is offered reflects fair and equitable rates, aligned with comparable roles, expertise and responsibilities. For each payment, individuals are asked to estimate the number of hours spent reviewing, preparing, or attending meetings. Low barrier payment options (e.g., cash or e-transfer) are be offered. Compensation is be agreed upon prior to initiating guideline activities, and is be revisited if roles and/or expectations change.
Additional Resources
While the above provides an overview of resources used in the develop of CRISM guidelines, the McMaster University – GRADE Centre also provides guideline development tools and resources. This includes the GIN-McMaster Guideline Development Checklist which is a comprehensive list of topics and items outlining the steps to be considered when developing a guideline.