gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

How can guideline recommendations on disease specific ethical issues be developed in a systematic and transparent manner? Opportunities and challenges within seven methodological steps

Meeting Abstract

  • D. Strech - Hannover Medical School, Hannover, Germany
  • H. Knüppel - Hannover Medical School, Hannover, Germany
  • G. Neitzke - Hannover Medical School, Hannover, Germany
  • M. Schmidhuber - Hannover Medical School, Hannover, Germany
  • M. Mertz - Hannover Medical School, Hannover, Germany; University of Mannheim, Mannheim, Germany

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP052

doi: 10.3205/12gin164, urn:nbn:de:0183-12gin1647

Published: July 10, 2012

© 2012 Strech et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Clinical practice guidelines (CPG) aim to improve standards of clinical performance. To deal adequately with disease specific ethical issues (DSEI) is deeply intertwined with the concepts of clinical competence. Current CPG development manuals, however, fail in addressing methods for the systematic and transparent integration of DSEI.

Objectives: To present the crucial steps in developing CPG recommendations on DSEI and to illustrate how these steps can be taken more or less systematically and transparently.

Methods: We performed a systematic review of literature that addresses DSEI in dementia care. The included literature was then analyzed qualitatively in order to develop a theoretically saturated spectrum of DSEI for dementia care (presented at the G-I-N 2011 conference). Based on standard of normative analysis and guideline development (e.g. GRADE) we outline further procedural steps that are necessary for the development of CPG recommendations on DSEI.

Results: Besides a systematic review (i) and qualitative analysis (ii) of DSEI necessary procedural steps for developing CPG recommendations on DSEI are selecting key-DSEI from the full spectrum of DSEI (iii), reviewing additional literature that addresses normative arguments and relevant characteristics with respect to key-DSEI (iv), drafting normative recommendations that balance practicability, simplification and usefulness (v), consenting such normative recommendations (vi), evaluating implementation of normative recommendations (vii).

Discussion: Because an adequate conduct in DSEI is deeply intertwined with the concepts of clinical competence and professionalism CPGs should include recommendations on key-DSEI within their set of practice recommendations.

Implications for guideline developers/users: Manuals for guideline developers should be complemented regarding guidance on how to search, select and include DSEI.