[Experiences from practical guideline development--proposal of a more standardized guideline development process]

In this article, the authors of the ,,General Practitioners' Guideline for the Diagnosis and Treatment of Urinary Incontinence" describe the logical and procedural steps involved in the development process of this evidence-based GPs' guideline for the management of urinary incontinence. Specifically, the following factors have been identified as crucial for a successful primary care guideline development process: The work group (authors) should comply in size with current recommendations for successful project work teams. It is recommended that authors should belong to opposing ends of the spectrum of practical versus theoretical medicine. We argue that the integration of both practical experience and theoretical knowledge/research experience be combined in order to collate guideline recommendations that are firmly grounded in scientific evidence and both applicable and acceptable in everyday practice. Proper work on a guideline development project should only start after ensuring that the well-known theoretical requirements for sensible guidelines are met, i.e. the problem in our special focus should be widespread or of considerable economic/public health importance, be amenable to proper medical intervention, and some quality issue regarding the current handling of this problem should have been demonstrated. Subsequently, a clear logical analysis of the problem's inherent functional/logical/practical subdivisions has to be conducted. Each author is then allocated his or her fair share of the work. The next step is considered to be extremely important and consists of discovering one's "illusive correlation", i.e. inherent ideas one has on the subject without being aware of one's own bias. The proposed "trick" now consists of making the implicit bias an explicit fact in the further guideline development process. The remaining work steps build on the integration of one's preformed ideas with current, published opinion from standard textbooks, as well as existing guidelines and non-guideline recommendations on the subject; plus taking into account the practical experience gathered from interviews and "on-location-visits". This integration process is performed within a structured framework to facilitate objectivity and transparency of the entire guideline.