Methodologies for the Development of CHEST Guidelines and Expert Panel Reports

BACKGROUND: American College of Chest Physicians’ (CHEST) new Living Guidelines Model will not only provide clinicians with guidance based on the most clinically relevant and current science but will also allow expert-informed guidance to fi ll in any gaps in the existing evidence. Th ese guidance documents will be updated, as necessary, using one or more of three processes: (1) evidence-based guidelines, (2) trustworthy consensus statements, and (3) a hybrid of the other two. The new Living Guidelines Model will be more sustainable and will encourage maintenance of current and targeted recommendations and suggestions. METHODS: Over recent years, the Guidelines Oversight Committee (GOC), which consists of CHEST members with methodologic experience and other stakeholders, developed a rigorous process for evidence-based clinical practice guidelines. Th is guideline methodology will be used to the greatest extent permitted by the peer-reviewed literature. However, for some important problems clinicians seek guidance but insuffi cient research prevents establishing guidelines. For such cases, the GOC has created a carefully structured approach permitting a convened expert panel to develop such guidance. Th e foundation of this approach includes a systematic review of current literature and rigorously vetted, entrusted experts. RESULTS: Existing evidence, even if insuffi cient for a guideline, can be combined with a Delphi process for consensus achievement resulting in trustworthy consensus statements. Th is article provides a review of the CHEST methodologies for these guidance documents as well as the evidence-based guidelines. CONCLUSIONS: Th ese reliable statements of guidance for health-care providers and patients are based on a rigorous methodology and transparency of process. CHEST 2014; 146(1):182192