Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage...

Area of Science:

• Oncology
• Clinical Practice Guidelines
• Head and Neck Cancer Management

Background:

• Developing national recommendations requires clinician buy-in and consideration of resource constraints.
• Existing methods for guideline development vary widely.
• This initiative focused on creating guidelines for head and neck squamous cell carcinoma of unknown primary (HNSCCUP).

Purpose of the Study:

• To develop national guidelines for HNSCCUP management.
• To employ a novel methodology to maximize the likelihood of national adoption of new guidance.
• To address the variability in HNSCCUP management practices.

Main Methods:

• A 3-phase development process overseen by a voluntary steering committee.
• Phase 1: Data collection including systematic reviews and a National Audit of Practice.
• Phase 2: National Consensus Day for generating candidate statements.
• Phase 3: National Delphi Exercise involving UK Head and Neck Multidisciplinary Teams (MDTs) for agreement.
• Methodology published online in advance.

Main Results:

• 227 participants attended the National Consensus Day.
• 35 statements were generated for voting, leading to 30 entering the Delphi exercise.
• After 3 Delphi rounds, 27 statements reached 'strong agreement' and 1 reached 'agreement'.
• 28 statements were adopted into the National MDT Guidelines for HNSCCUP.
• Response rate for Delphi rounds was 98%.

Conclusions:

• The multi-phase strategy effectively developed national practice recommendations for HNSCCUP.
• This methodology can serve as a cost-effective model for rare or controversial conditions.
• The approach is suitable for conditions with limited evidence or significant practice variability.