临床实践指南制定方法——指南范围、主题及问题的确定

摘要

指南主题的确定是指南构建的首要步骤,合理规范的指南主题是构建临床需要的指南和保证指南如期完成的重要条件.此过程中常常需要确定范围、主题或议题、问题三类.范围与主题较宏观,问题更具体和明确,临床问题是制定文献检索与系统评价并最终形成推荐意见的基础.范围和主题的确定有多项原则,比如:邀请利益相关方进行讨论确定;优先制定严重疾病负担、临床实践变异大、文献基础较好的主题.临床问题的确定依据PICO模式.%Only when the scope is well defined will it be possible to develop guideline meeting the clinical requirement, assess the workload and timescale of the guideline development process. Scope and topic involve considering in detail the areas of clinical practice that will be addressed by the guideline. There are some key principals: inviting the coordinators of all interest groups or stakeholders to propose and discuss new guideline topics; giving priority on topics with high costs, major patient impact; high practice variation. The questions listed in the scope or topic need to be translated into review questions for developing review questions and planning the evidence review. Clinical questions should be more clear and focused. A helpful framework to format key questions systematically is the PICO framework.