Objectives Great challenges lay ahead of scientific societies as providers of guidance documents. On one hand, they are under increased scrutiny to develop trustworthy and useful guidelines; it has even been advocated that professional societies should abstain from authoring guidelines and disease definition statements. On the other hand, scientific societies are requested by clinicians, policy makers and patients alike, to be more efficient in producing guidance documents on a large number of topics, often in the absence of strong evidence upon which to base recommendations.
The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) is revising its programme for guideline development to meet the huge challenges in how guidance documents are perceived (trustworthy guidelines) and developed (useful guidelines). We discuss here lessons learnt and plans for the future.
Method ESCMID (founded in 1983) is Europe’s leading society in clinical microbiology and infectious diseases, with 30,000 members from all European countries and all continents, 30 study groups, and many national and international affiliated institutions. ESCMID is part of the Guidelines International Network. In the past few years, many guidance documents were produced under the ESCMID name; however, ESCMID’s main role was one of networking, general oversight and peer review. Staff was limited to 0.5 full-time equivalents, with only an administrative role. The role of the guideline director was liaison between potential drafting groups and the Executive Committee, general oversight of conflict of interest, coordination with other scientific societies in cooperative projects. Industry-funding of guidelines has never been accepted. Since 2017, we reviewed our procedures and developed a strategy to improve quality, rigour and transparency of guidelines issued by our society.
Results The three main challenges we identified are: conflicts of interest of members and society, leading to potentially biased guidance; lack of knowledge of methods in guideline development even among experienced members (with resistance to change as an additional consequence); reliance on commitment of individual professionals, leading to risk of poor sustainability. In response, we have devised a multifaceted intervention. We are involving, via open calls, a larger number of professionals, to create a network (not limited to Europe) able to manage, control, monitor and oversee the many practical, scientific and ethical issues involving clinical guidance documents. We created different bodies/groups, to ensure reciprocal oversight on different activities. We involved stakeholders globally, to select priority topics, with appropriate funding. We are organizing online and face-to-face training on guideline development methods and implementing tools to assist guideline development groups. Most importantly, we are updating our policy and strategy for conflict of interest control and management.
Conclusions The science and art of guidance production is complex and important in these times of information overload, resource constraints in health care and shrinking research budgets. We highlighted many issues awaiting guideline production in our fields of medicine and are working to address them. The pillars of our strategy are to: select cutting-edge guideline topics, apply an independent and rigorous methodology; ensure a global perspective; appoint members to guideline-related tasks based on merit; involve young ESCMID members to ensure sustainability of the model; strictly monitor conflict of interest declarations.
We here call for external, independent, advisors to participate in our programme.
We are confident that, with the contribution of excellent professionals (ESCMID and not), and with the balances and checks in our new structure, we will meet the high challenges we are facing, and that professional societies can still play a role in producing trustworthy and useful clinical guidance documents.
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