using GRADE-type profiles to capture both clinical- and cost-effectiveness evidence.TARGET AUDIENCE(S):

1. Clinical researcher2. Evidence synthesizer, developer of systematic reviews or

meta-analyses3. Guideline developer4. Developer of guideline-based products5. Quality improvement manager/facilitator6. Health care policy analyst/policymaker

S64– A new approach to advice for guideline

developers

Kay C. Currie, MPH (Presenter) (NHMRC’s NationalInstitute of Clinical Studies, Hampton, Victoria,Australia); Geraint R. Duggan (NHMRC’s NationalInstitute of Clinical Studies, Melbourne, Victoria,Australia); Heather Buchan (NHMRC’s NationalInstitute of Clinical Studies, Melbourne, Victoria,Australia); Emma Tavender (EPOC, Melbourne,Victoria, Australia); Catherine Marshall (IndependentGuideline Advisor & Health Consultant,Waipukurau, New Zealand); Tari Turner (NationalTrauma Research Institute, Melbourne, Victoria,Australia); Marie Misso (Australasian CochraneCentre, Clayton, Victoria, Australia);Tanyth de Gooyer (NHMRC’s National Institute ofClinical Studies, Melbourne, Victoria, Australia);Catherine King (NHMRC’s National Institute ofClinical Studies, Melbourne, Victoria, Australia)

PRIMARY TRACK: Guideline developmentSECONDARY TRACK: Other guidelines developmentBACKGROUND (INTRODUCTION): Manuals for evi-dence-based clinical practice guideline development have beenwritten by many national bodies involved in guidelines outlin-ing the requisites of best practice. These have escalated incomplexity and volume as the methodologies of systematicliterature review and appraisal, guideline development, andtools such as AGREE and ADAPTE have sought to improvethe quality of clinical practice guidelines.LEARNING OBJECTIVES (TRAINING GOALS):

1. Identify new methods of providing advice.2. Test formats for the provision of advice to guideline

developers.METHODS: The basic steps in guideline development arerarely in dispute, but the application of these principles is oftenlimited by the resources available. More controversial is thehow-to and identification of which elements are essential toproduce a “good” clinical practice guideline. There is littleagreement on what is a good guideline, with differences oftendependent on perspective, for example between the methodol-ogist and the clinician end user.RESULTS: The National Health and Medical ResearchCouncil (NHMRC), an established leader in the developmentof guideline advice with the production of a series of manuals

covering the full breadth of guideline development, is nowseeking to review and update its advice. The National Instituteof Clinical Studies, an institute of the NHMRC, has com-menced this task by building on existing international re-sources where applicable, and by developing a new format. Itis an explicit user-friendly guide that will use electronic for-mats to provide the amount and level of information requiredby guideline developers.DISCUSSION (CONCLUSION): This presentation willdescribe the processes involved in developing these require-ments and the outcomes of this novel approach to providingadvice to guideline developers.TARGET AUDIENCE(S):

1. Clinical researcher2. Evidence synthesizer, developer of systematic reviews or

meta-analyses3. Guideline developer4. Guideline implementer5. Developer of guideline-based products6. Quality improvement manager/facilitator7. Medical educator8. Health care policy analyst/policymaker9. Health insurance payers and purchasers10. Medical providers and executives11. Allied health professionals12. Consumers’ and patients’ representatives13. Nurses

S65– Cancer survivorship plan in the Netherlands:

A guideline for professionals in oncology

Yvonne Snel, PhD (Presenter) (Association ofComprehensive Cancer Centres, Utrecht,Netherlands)

PRIMARY TRACK: Guideline developmentSECONDARY TRACK: Other guidelines developmentBACKGROUND (INTRODUCTION): Due to the immenseincrease in people living with cancer in the forthcoming years,the shortage of health care and dysfunction of the follow-upsystem is expected in the Netherlands. The Ministry, medicaloncologists, health-care professionals, and cancer patients em-phasize the lack of evidence for the present follow-up strate-gies in detecting new cancer manifestations. At the same time,the follow-up strategies are inadequate in signalizing, guid-ance, and treatment of the side effects of cancer and its treat-ments.LEARNING OBJECTIVES (TRAINING GOALS):

1. Develop an evidence-based guideline on survivorshipcare.

2. Using an interactive method, named Open Space, toinvestigate the perspectives of cancer patients.

METHODS: We formed multidisciplinary working groupsrepresenting medical oncology, surgery, radiotherapy, generalpractitioners, nursing, psychology, and rehabilitation. The prin-ciples of the cancer survivorship care in the USA and else-where were studied. The evidence for adequate aftercare for

45Oral Presentation

cancer survivors was investigated by the general method forevidence-based guidelines. In a conference the perspectives ofcancer patients regarding aftercare have been investigated bythe Open Space method.RESULTS: An evidence-based guideline for cancer survivor-ship care was developed. This includes important recommen-dations for the duration of the aftercare period (reconsiderationof aftercare one year after cancer treatment), the method ofdetecting cancer manifestations, and providing an individualcancer survivorship care plan for every patient. These recom-mendations for cancer survivorship care are completed with aformat of a cancer survivorship care plan, instructions forpatient education, and a checklist for implementing the recom-mendations in tumor-specific guidelines.DISCUSSION (CONCLUSION): The guidelines promotethe efficiency and quality of cancer survivorship care in a timeof rapidly increasing needs for cancer care. By this, unneces-sary medicalization is prevented and self management, recov-ery, and quality of life of cancer survivors are promoted.TARGET AUDIENCE(S):

1. Clinical researcher2. Guideline developer3. Guideline implementer4. Developer of guideline-based products5. Quality improvement manager/facilitator6. Medical educator7. Health care policy analyst/policymaker8. Health insurance payers and purchasers9. Medical providers and executives10. Allied health professionals11. Consumers’ and patients’ representatives12. Nurses

S66– Clinical guidelines development in

Kazakhstan Republic according to modern

requirement

Laura Halikovna Kozhageldieva, MBA (HealthcareDevelopment Institute, Astana, Kazakhstan);Lyazzat Kosherbayeva (Presenter) (HealthcareDevelopment Institute, Astana, Kazakhstan);Evgeniya Pak (Healthcare Development Institute,Astana, Kazakhstan);Kulsara Rustambekovna Rustemova (HealthcareDevelopment Institute, Astana, Kazakhstan)

PRIMARY TRACK: Guideline developmentSECONDARY TRACK: Other guidelines developmentBACKGROUND (INTRODUCTION): The quality of med-ical care in Kazakhstan does not meet the international stan-dards, due to the absence of a modern system of accreditationof health-care organizations, limited use of clinical guidelines,practical use of evidence-based medicine principles and healthtechnology assessment, and also the absence of an administra-tion system of quality in health-care organizations. The Min-istry of Health, together with the Healthcare DevelopmentInstitute and other organizations, developed and approved

nearly 200 clinical guidelines. Nowadays, this process is basedon the stable methodological procedures and modern interna-tional experience, as the involvement of professional associa-tions for consultation and research. Currently it is expected tomodernize and expand the range of this work, to involve inprofessional associations, to strengthen the capacity of MoH toensure the quality.LEARNING OBJECTIVES (TRAINING GOALS):

1. Strengthening the capacity of Kazakhstan health sectorin the clinical guidelines development based on interna-tional standards.

2. Improvement of 50 clinical guidelines to the main fivespecialties.

METHODS: The main two methods are planning to use:1. expert board approval; 2. AGREE instrument use.RESULTS: The increase of the medical care quality throughthe development of a single data base system for timely clinicalguidelines improvement.DISCUSSION (CONCLUSION): As world practice shows,the development of clinical guidelines is a serious problem.The solution of this problem demands the regulatory and in-stitutional changes as well as changes to the nature of the entiresystem of existing relationships and attitudes of medical per-sonnel. The implementation of the tasks will destroy the purelyadministrative practice and help to establish a comprehensivequality management system aimed at improving health care,efficient use of budgetary resources, and increasing the respon-sibility of medical professionals for their services.TARGET AUDIENCE(S):

1. Clinical researcher2. Guideline developer3. Guideline implementer4. Allied health professionals

S67– Diliguide: A web-based tool for guideline

development and implementation

Danielle Sent, PhD (Presenter) (Dutch Institute forHealthcare Improvement, Utrecht, Netherlands);Kitty Rosenbrand, MD (Dutch Institute forHealthcare Improvement, Utrecht, Netherlands);Ilse Raats, PhD (Dutch Institute for HealthcareImprovement, Utrecht, Netherlands);Judith van der Vloed, MSc (Dutch Institute forHealthcare Improvement, Utrecht, Netherlands)

PRIMARY TRACK: Guideline developmentSECONDARY TRACK: Other guidelines developmentBACKGROUND (INTRODUCTION): During the guide-line development process adequate assistance of the guidelinedevelopment group for writing, commenting, and editing textis absolutely necessary but time consuming. Also, public con-sultation on the draft guideline is often an inefficient andchaotic process and publication of paper guidelines is expen-sive and no longer sufficient to accomplish good implementa-tion. Since web-based applications are now commonly used,we decided to develop a web-based tool, called “Diliguide,”

46 Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010