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What do medical guidelines normally include?

A guideline document normally includes:

  • An overview of the guideline, including its purpose and how it should be read
  • The contents of the guideline, such as a table of contents with page numbers
  • The context, such as background information on the disease and its prevalence
  • The rationale/methodology, summarising the evidence behind the recommendation and explaining how the recommendations were derived from the evidence
  • Details of the evidence, including any analysis, modelling, and gaps in the evidence
  • The committee’s discussion – the rationale for the recommendations, their likely impact on practice, and how the Committee developed them, with links to evidence
  • The recommendations, normally divided into different themes such as diagnosis and treatment
  • Recommendations for further research
  • Links to more information and resources
  • Information about the guideline, including date of publication, changes from past versions, members of the committee, and declarations of interest
  • Who to contact if the reader wants more information or to recommend updates
  • A glossary of terms used within the guideline

This list is drawn from the NICE website and examples of existing guidelines.

The NICE guideline development process

The following information should help you to understand the formal procedures for developing credible medical guidelines in line with the NICE process.

NICE, the public organisation in England that develops and provides medical guidelines, has outlined their guideline development process on their website.

 The NICE process follows these key stages:

 

 

What types of recommendations can medical guidelines make?

Most medical guidelines give recommendations on the following three key areas:

  • Diagnosis: how to identify the disease, including recommendations on which tests to use and when. This section can be subdivided – e.g. into clinical assessment and laboratory investigations to support diagnosis.
  • Management: how to manage the symptoms of the disease. This can include drugs that help to manage the condition and lifestyle interventions.
  • Treatment: how to treat the disease in different people and situations. Rare diseases that do not have a treatment are unlikely to need this section.

These three areas may be divided into certain themes, and additional topics may be covered depending on the specifics of the disease. For instance:

  • The Lyme Disease Guideline has the section ‘Awareness of Lyme disease’, which describes how Lyme Disease can be contracted and transmitted. Understanding this is important for prevention and diagnosis.
  • The Glaucoma Guideline has recommendations specifically for primary eye care professionals on ‘Case-finding’. This includes a list of tests they should conduct before referring patients for further investigation and diagnosis.
  • The Cystic Fibrosis Guideline has a section on ‘Information and support’. This includes recommendations on the information and support that should be offered to patients and families at different times of their lives, including lifestyle support and emotional support.
  • The Lyme Disease Guideline includes a section on management for women with ‘Lyme disease during pregnancy and their babies’.
  • The recommendations for treatment in the Asthma Guideline are divided into age groups: adults aged 17 and over; children and young people aged 5-16, and children under 5.
  • The Familial Hypercholesterolaemia Guideline has a section on ‘Ongoing assessment and monitoring’, which tells healthcare professionals how they should monitor the health of patients and when they should refer them to a specialist.
  • Lots of guidelines have ‘Recommendations for research’ sections, which outline gaps in existing knowledge and related research questions. The Lyme Disease Guideline and the Cystic Fibrosis Guideline both have this section.

Details of these examples may change as the guidelines are updated in the future.

Please note that the types of recommendation included should be driven by the evidence available and not simply by what the developers want to include. If there are any gaps in evidence, these can be written into a ‘Recommendations for research’ section.