Evidence-Based Medicine and Practice Guidelines - An Overview

Steven H.Woolf, MD, MPH, Department of Family Practice, Medical College of Virginia - Virginia Commonwealth University, Fairfax, Virginia.

Cancer Control. 2000;7(4) 

In This Article

Practice Guidelines

For decades, practice guidelines -- official statements from organizations and agencies regarding the appropriate use of procedures and treatments -- have relied on informal methods to weight these issues. Typically, a group of experts gather around a conference table and are asked to make recommendations, based on their understanding of the evidence and on their opinion. No formal methodology for reviewing evidence or arriving at consensus is followed, and whatever methods and rationale are used tend not to be recorded in the final document. Formal consensus development techniques have been used, most notably in National Institutes of Health Consensus Development Conferences [12] and the Rand appropriateness panels, [13] but even in these approaches, the panelists still reach conclusions based on opinion.

Disfavor over these methods has grown in recent years due to concerns about vulnerability to bias and conflicts of interest. [14] Many groups have turned to EBM for guideline development. Evidence-based practice guidelines feature an explicit methodology, include as their foundation a systematic review of the evidence, provide graded recommendations that are linked directly to the supporting evidence, and state explicitly when recommendations are based on opinion.