Practitioners as experts: The influence of practicing oncologists "in-the-field"' on evidence-based guideline development

Purpose Panels of experts are used to develop clinical practice guidelines (CPGs) intended to be used by practitioners "in-the-field." Therefore, oncologists' participation in CPG development is an important strategy to promote CPG adoption. The purpose of this study was to evaluate the contributions of oncologists in-the-field to evidence-based CPG development using data from Ontario's cancer system. Methods CPG development in Ontario includes surveys of oncologists' opinions, using a structured about draft recommendations that were developed from rigorous systematic questionnaire, reviews of evidence prepared by expert panels. Two research assistants reviewed background documents to trace the changes in CPG recommendations from draft to final stage to determine the contribution of oncologists' input to final recommendations. Changes to recommendations were categorized as either substantive (content or tone) or minor (ideas clarification or edits). Results From 2000 to 2003, 43 CPGs were developed. There were 87 changes to draft recommendations for 31 CPGs of which 40 changes to 19 CPGs could be attributed to survey input from practicing oncologists. Of the 40 changes, 28 (70%) were judged to be substantive. Conclusion Despite a rigorous evidence-based process for CPG development, practicing oncologists contribute substantially to the final recommendations approved by the expert panel. It is hypothesized that the responsiveness of expert panels to input from oncologists in-the-field will facilitate adoption of CPGs.