From best evidence to best practice

The World Health Organization proposes that a third of all cancer cases could be prevented, another third cured, and the rest effectively managed if care consistently complied with existing evidence-based strategies.^1,2

This bold vision for standardized care is centred on the systematic development of cancer control guidelines and their effective implementation throughout clinical practice. Now, thanks to a comprehensive set of guideline development resources at the Guidelines Resource Centre, the Canadian Partnership Against Cancer is supporting this effort on a national scale.

What are guidelines?

Guidelines are documents that help the cancer community make sound decisions regarding the prevention, screening, diagnosis, management, and treatment of cancer. Based on the most up-to-date and rigorous scientific and medical evidence, guidelines help busy physicians and other health professionals navigate through a sea of drug discoveries, ever-evolving practices and conflicting research results. While they don’t take the place of professional judgment, guidelines offer a solid base of evidence for decision-making by doctors and their patients.

The rigorous, systematic process by which high quality guidelines are developed takes extensive knowledge, clinical resources and time. A single guideline document can take a year or more to develop, involving clinical experts, program staff and external reviewers. This has posed a significant barrier for many Canadian provinces and territories, which are each responsible for developing guidelines that reflect their local context and capacity.

Jill Petrella at Cancer Care Nova Scotia (CCNS) has first-hand experience with this issue. As the manager responsible for coordinating guideline development for CCNS, she has spent more than a decade working with others across Canada to advance the support for guideline development that she herself needs.

“In Nova Scotia, we don’t have the resources to be doing brand new systematic reviews for every cancer guideline,” she explains. “What we need is better access to existing information and resources, training to improve our knowledge and capacity, and support to help us develop our guidelines the best way we can.”

As part of its mandate to support a national cancer strategy, the Partnership committed to addressing this need early on. “The guideline development community is rather small and it’s a bit of a patchwork across the country,” acknowledges Dr. George Browman, Chair of the Guidelines Advisory Group at the Canadian Partnership Against Cancer. “We saw that the Partnership could really contribute by creating centralized resources that everyone could access — not only guidelines professionals but also the much larger community of professionals who deliver cancer care — to improve the quality and uniformity of practice for patients across the country.”

In 2007, the Partnership began funding the Capacity Enhancement Program (CEP), which is based at McMaster University. Today, the CEP offers a variety of key resources developed by and for Canada’s guideline development community.

At the centre of the program is the Guidelines Resource Centre, where visitors will find a one-stop shop of tools to help cancer guideline developers across the country, including access to two main resources: The SAGE Directory of Cancer Guidelines and the Guidelines Resource Centre.

The SAGE Directory of Cancer Guidelines is a searchable database of almost 1,900 cancer guidelines – a quarter of which have been developed in Canada – that have already been assessed for quality. The inventory also houses listings of guidelines in development, and guidelines in need of an update, to facilitate collaboration between developers.

The Guidelines Resource Centre houses reference materials and tools to support practice guideline development, including how-to manuals, templates, checklists and key publications. Visitors can also access presentations, webinar recordings and popular YouTube videos that target specific issues in guideline development and implementation.

A third area of focus for the CEP is the development of sustainable communities of stakeholders through in-person and online training initiatives centred on the use and appraisal of scientific evidence and guideline development methodologies. Since its inception, the CEP has hosted a total of 18 training events reaching 427 people. A consistent theme of participant feedback is the ability to access information and educational opportunities that wouldn’t otherwise be available.

Back in Nova Scotia, Jill Petrella is taking full advantage of these resources. “We’ve seized every single opportunity they’ve provided,” she recounts. She recently submitted CCNS’s newly-developed thyroid cancer guideline to the program’s Inter-Provincial External Review service, which coordinates expert review of the document on behalf of the organization.

She’s also enthusiastically sharing CEP’s educational opportunities with colleagues outside the cancer field. “When the program offers its webinars, I invite other guideline developers in the Nova Scotia Department of Health and Wellness,” she says. “We’ve got people working in diabetes, cardiovascular health and renal care all in the conference room together learning from the methodology used in cancer. Without a doubt, it’s improving our knowledge and capacity – and our potential to develop guidelines that improve practice.”

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Notes

¹ World Health Organization. National Cancer Control Programmes: Policies and Managerial Guidelines, 2002. http://www.who.int/cancer/media/en/414.pdf, accessed February 2012.
² World Health Organization. Cancer Control: Knowledge into Action. WHO Guide for Effective Programmes, Diagnosis and Treatment, 2008. http://www.who.int/cancer/modules/FINAL_Module_4.pdf, accessed February 2012.