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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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How equity is addressed in clinical practice guidelines: a content analysis.

Chunhu Shi1, Jinhui Tian1, Quan Wang2

  • 1Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.

BMJ Open
|December 7, 2014
PubMed
Summary

This review synthesizes methods for incorporating equity into clinical practice guidelines (CPGs). Eight themes and eight methodological issues were identified to guide equity considerations in CPG development for disadvantaged populations.

Keywords:
PUBLIC HEALTHQUALITATIVE RESEARCH

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Area of Science:

  • Health Services Research
  • Clinical Practice Guidelines
  • Health Equity

Background:

  • Incorporating equity into clinical practice guidelines (CPGs) presents significant methodological challenges.
  • Addressing health disparities requires systematic methods for equity consideration in guideline development.

Purpose of the Study:

  • To qualitatively synthesize the methods for incorporating equity considerations into clinical practice guidelines (CPGs).
  • To identify key themes and methodological issues relevant to equity in guideline development.

Main Methods:

  • Content analysis of methodological publications providing checklists or frameworks for equity in CPGs.
  • Systematic electronic searches of MEDLINE and guideline development organization websites.
  • Extraction and thematic grouping of 87 questions/items from 17 checklists/frameworks.

Main Results:

  • Eight studies yielded 10 publications, generating 87 questions/items grouped into eight themes.
  • Themes included scoping, evidence searching and appraisal, recommendation formulation, implementation monitoring, and reporting.
  • Four studies addressed more than five themes, providing a summarized process for guideline development.

Conclusions:

  • Eight critical methodological issues should be considered when incorporating equity into CPGs, particularly for disadvantaged populations.
  • Guideline development manuals should guide the integration of these equity considerations.
  • Systematic approaches are essential for developing equitable clinical practice guidelines.