Clinical guidelines exist to reduce variation in care, but the way they are chosen and developed is itself inconsistent. Guidance can take as long as 17 years to reach practice, only a small fraction of recommendations are ever implemented, and unclear development processes leave many guidelines open to bias. For UK kidney care, there was no agreed standard for how guideline topics should be selected, designed and put into practice.
To define one, the UK Kidney Association convened a multidisciplinary panel that developed 35 statements. These were tested through a modified Delphi consensus, using two surveys, one for healthcare professionals and one for patients and their representatives, so both perspectives shaped the outcome. In total, 419 people responded, including 364 clinicians and 41 people living with kidney disease. Consensus was pre-specified at 75% agreement.
Clinicians reached consensus on 32 of the 35 statements, 28 of them at 90% or above, and patients reached consensus on all 20 of their statements. The six recommendations call for a more equitable way of proposing guideline topics with input from patients as well as clinicians, guidance written in clear and accessible language, and standardised techniques to help recommendations reach practice.
Triducive acted as the independent facilitator for this modified Delphi consensus, generating the statements and analysing the responses. Acting on the recommendations could make the guideline process more transparent and accountable, and its output more usable in day-to-day kidney care.
Burton JO, et al. BMJ Open, 2024; 14(6): e085723. DOI: 10.1136/bmjopen-2024-085723
