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When evidence is lacking:a mixed-methods approach for the development of practice guidance in liver transplantation

Gastroenterology Report 2021年第1期9卷 22-30,I0001页

作者： Lisa B.VanWagner Blessing Aghaulor Tasmeen Hussain Megan Kosirog Patrick Campbell stewart pine Amna Daud Daniel J.Finn Josh Levitsky Donald M.Lloyd-Jones Jane L.Holl Division of Gastroenterology and Hepatology Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA Department of Preventive Medicine Northwestern University Feinberg School of MedicineChicagoILUSA Comprehensive Transplant Center Northwestern University Feinberg School of MedicineChicagoILUSA Division of Cardiology Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA Department of Pediatrics Northwestern University Feinberg School of MedicineChicagoILUSA Center for Healthcare Delivery Science and Innovation and Department of Neurology Biological Sciences DivisionUniversity of ChicagoChicagoILUSA

Background Most interventions for conditions with a small cohort size,such as transplantation,are unlikely to be part of a clinical *** condition-specific evidence is lacking,expert consensus can offer more precise guidance to improve *** of cardiovascular risk in liver-transplant recipients is one example for which clinicians have,to date,adapted evidence-based guidelines from studies in the general ***,even when consensus is achieved,implementation of practice guidance is often inadequate and *** report on a novel mixed-methods approach,the Northwestern MethodVC,for the development of clinical-practice guidance when condition-specific evidence is *** illustrate the method through the development of practice guidance for managing cardiovascular risk in liver-transplant *** The Northwestern MethodVC consists of(i)adaptation of relevant,existing,evidence-based clinical-practice guidelines for the target population;(ii)consensus by experts of the proposed practice guidance;(iii)identification of barriers to guidance adherence in current practice;and(iv)recommendation for implementation and dissemination of the practice *** method is based on an iterative,user-centered approach in which the needs,wants,and limitations of all end users,including patients,are attended to at each stage of the design and development *** The Northwestern MethodVC for clinical-practice-guidance development uses a mixed-methods approach to bring together broad representation from multiple disciplines and practice settings to develop consensus considering the unique needs and preferences of patients,caregivers,and practitioners who are directly impacted by clinical-practice-guidance *** hypothesize that a priori involvement of end users in the guidance-development process will lead to sustainable implementation of guidance statements into clinical practice.

关键词： liver transplantation practice guideline consensus methodology

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