SIGN 50: A guideline developer's handbook - Section 8: Consultation and peer review

Section 8: Consultation and peer review

8.1 NATIONAL OPEN MEETING

The AGREE instrument suggests that guidelines should be pilot-tested prior to publication. SIGN considers that the pilot-testing phase is more appropriately carried out at a local level as part of the local implementation process, as testing the feasibility of implementation in one environment may not be applicable to another. However, as an early stimulus to this process, SIGN holds a national open meeting to discuss the draft recommendations of each guideline. This takes place whilst the guideline is still in development and gives the guideline development group the opportunity to present its preliminary conclusions and draft recommendations to a wider audience. The benefits of the national open meeting are twofold:

the guideline development group obtains valuable feedback and suggestions for additional evidence which group members might consider, or alternative interpretation of that evidence
the participants are able to contribute to and influence the form of the final guideline, generating a sense of ownership over the guideline across geographical and disciplinary boundaries.

SIGN national open meetings are widely publicised and are usually attended by between 150 and 300 healthcare professionals and others interested in the guideline topic, including patient representatives, from across Scotland. Advertising of the meetings is targeted on those professional and patient representative groups most likely to have an interest in the topic. Particular efforts are made to ensure that all equality groups with a potential interest in the topic are represented.

The meetings are registered for CPD (Continuing Professional Development) and for EPASS (Educational Providers Accreditation Scheme Scotland) accreditation. The draft guideline is also available on the SIGN website for a month at this stage to allow those unable to attend the meeting to contribute to the development of the guideline.

The national open meeting is the main consultative phase of SIGN guideline development. Although the draft guideline is circulated to Directors of Public Health and to a number of health service organisations at a later stage, this is more as a courtesy to inform them of the likely content of the final guideline than for consultation.

8.2 PEER REVIEW

All SIGN guidelines are reviewed in draft form by independent expert referees, who are asked to comment primarily on the comprehensiveness and accuracy of interpretation of the evidence base supporting the recommendations in the guideline. A number of GPs and other primary care practitioners also provide comments on the guideline from the primary care perspective, concentrating particularly on the clarity of the recommendations and their assessment of the usefulness of the guideline as a working tool for the primary care team. The draft is also sent to at least two lay reviewers in order to obtain comments from the patient’s perspective.

It should be noted that all reviewers are invited to comment as individuals, not as representatives of any particular organisation or group. Corporate interests, whether commercial, professional, or societal have an opportunity to make representations at the national meeting stage where they can send representatives to the meeting or provide comment on the draft produced for that meeting. Peer reviewers are asked to complete a declaration of interests form.

The comments received from peer reviewers and others are carefully tabulated and discussed with the Chair and with the guideline development group. Each point must be addressed and any changes to the guideline as a result noted or, if no change is made, the reasons for this recorded. As a final quality control check prior to publication, the guideline and the summary of peer reviewers’ comments are reviewed by the SIGN Editorial Group for that guideline to ensure that each point has been addressed adequately and that any risk of bias in the guideline development process as a whole has been minimised. Each member of the guideline development group is then asked formally to approve the final guideline for publication.

The full editorial and consultation phase is illustrated in Figure 12. This process of extended consultation greatly enhances the validity of the final SIGN guideline and increases the likelihood that the guideline will be implemented successfully into local practice for the benefit of patients.

[Figure 12: Consultation and peer review]