gms | German Medical Science

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.