gms | German Medical Science

Background: Clinical practice guideline (CPG) development is time-consuming. The traditional approach (multiple sessions) has several problems, mostly in logistics and costs. Pressure-cook sessions (CPG development in a single conference, with an available evidence report) were tested.

Objective: To compare pressure-cook guideline development with traditional working group sessions regarding differences in recommendations, invested time and costs.

Methods: In a CPG for actinic keratosis, the traditional multiple sessions approach was compared to pressure-cooking. Both methods used the same evidence. Graded recommendations were compared across the guidelines. Outcomes registered were extent of accordance or discordance, costs and time frame.

Results: Intraclass correlations between levels of evidence and recommendation variation were significant. Pressure-cooking was cheaper and faster than the multiple sessions approach.

Discussion: We concluded that pressure-cooking is appropriate in topics with a limited body of evidence. To test whether pressure-cooking is worthwhile in extensive guidelines, we used it for a CPG about unknown primary tumors. We again experienced an enthusiastic working group and manageable costs, but no gain of time. After the pressure-cook session, we needed several discussion rounds to achieve a satisfactory guideline. This is probably due to the complicated and multidisciplinary character of the topic.

Implications for guideline developers/users: Pressure-cook sessions can limit time and costs of CPG development, without losing quality. However, there are a few conditions: extensive preparation, sufficient methodological support, willingness of the working group not to extend the scope of the guideline, and space for fine-tuning afterwards.