Providing clinical guidance in the middle of a global pandemic: Caveats and opportunities

Abstract

The Canadian Thoracic Society (CTS) has long been recognized for its high-quality clinical practice guidelines. Over the years, as recommended methods for guideline production have evolved, the CTS guideline process has become more rigorous and lengthier. In the context of the COVID-19 pandemic, this model was challenged by the urgent need for guidance, insufficient time for conventional guideline processes, and shrinking human resources and capacity. Accordingly, the CTS pivoted from guidelines to the more rapid, narrative, and informal “position statement” format. Having produced 17 COVID-related statements, the CTS saw its guideline website visits increase by 90% and downloads by 63% in 2020 versus 2019. However, providing rapid guidance in the form of position statements necessitates a significant tradeoff in the rigor of methodological processes used to arrive at recommendations. Previous research suggests that robust “rapid guidelines” may be feasible through modifications to conventional guideline development processes. Such approaches were successfully implemented by the Infectious Diseases Society of America (IDSA), the World Health Organization, and the UK’s National Institute for Health and Care Excellence (NICE) for COVID–19–related guidelines. Rapid guidelines have been made more feasible by better information sharing and advancing technologies such as an online COVID network meta-analysis engine and an app that allows organizations to author, publish and update digital guidelines. The CTS must continue to produce urgent guidance for decision makers, providers and the public alike in the context of this pandemic and should explore opportunities to espouse a standardized, rigorous and transparent process for rapid guidelines.