M. Hassan Murad, MD, is a clinical epidemiologist for the Mayo Clinic in Rochester, MN. He leads the Mayo Clinical Evidence-Based Practice Research Program and is a member of the GRADE working group

Evidence-based practice is central to successful patient care—not only in oncology but throughout the entire healthcare community. Currently, the way health care is delivered varies throughout the United States. Not all hospitals or clinics are the same, nor do all institutions operate the same. Many treatments are given to patients without clear evidence of the benefit, and unity and standardization are lacking, which could lead to wide variances in the efficacy and safety of care provided to patients.

Evidence is key when developing standardized care, and clinical practice guidelines are one of the necessary ways of unifying care to ensure patients are receiving the treatments, support, and interventions most consistent with the available knowledge base. Guidelines also help practitioners align care with patients’ values and preferences in a way that doesn’t sacrifice efficacy or safety during the treatment process.

Guideline development is an in-depth process that requires input from many stakeholders through the healthcare community. When setting out to create guidelines for practice, it helps to have a codified way of proceeding. Modern standards for guidelines have been proposed by many agencies and organizations, including the National Academies of Science, Engineering, and Medicine, and the most critical and important ones highlight that the evidence is selected by following an explicit and systematic approach. Data cannot be cherrypicked for use in guidelines, and the certainty in evidence must be explicitly assessed to be included. Evidence is the keystone in proper guideline development, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to guideline development is the favored method in practice because of its rigor and standardized steps for identifying evidence.

A newer national trend shows guidelines being published with a systematic review of the evidence included in the document, which helps clarify the evidence examined for guideline development. Furthermore, best practice now ensures that all relevant, interprofessional stakeholders are engaged in the guideline development process—no longer are the documents created by a closed-off team of a few individuals. As guideline development has progressed through the years, documents that offer brief, focused details are now more common than large, textbook-style documents.

Ideally, guidelines should also have implementation platforms and tools included or described in their publication. This can include strategies such as embedding recommendations into electronic medical records or care processes to ensure proper implementation in practice.

Creating new guidelines comes with several challenges. The process is often time consuming, and it can be difficult to incorporate the evidence with values. Furthermore, the role of expert opinion as a tool to understand the evidence—rather than a replacement of the evidence—can be tough to clarify. The GRADE approach framework can guide the process through those challenges, but methodologists and guideline panelists still require further training in that area.

Oncology nurses are key to the guideline development process and bring their unique experiences and breadth of expertise in evidence-based practice and patient-centered care to the table for practice change. Nurses interested in research and practicing clinical care based on the best-available evidence should seek additional training in evidence-based medicine, also known as clinical epidemiology. Nurses should consider engaging with their organizations and associations, like ONS, to fill the varied roles for developing or implementing clinical guideline recommendations.