A new method of analysis enabled a better understanding of clinical practice guideline development processes matter

Objective: To describe the process by which various forms of evidence are discussed, valued, and interpreted within the process of developing evidence-based clinical practice guidelines and, in so doing, to develop a method for such studies. Study Design and Setting: An observational study. Two guideline development groups were observed by a nonparticipant observer. The 21 meetings were recorded, transcribed, and analyzed using grounded theory and frame analysis. Qualitative analysis was complemented with descriptive statistics. Results: The groups organized their discussion around four domains-'science', 'practice', politics', and 'process'-and used boundary work to mediate between these domains. Both groups spent most time discussing 'science', followed by 'practice' or its relation with 'science'. Conclusion: Our analysis offers an innovative, replicable method of analysis of guideline development that permits the identification of the proportions and interrelations between knowledge domains deployed by guideline groups. This analysis also suggests that the participation hierarchy observed here and by others might be an effect of the imbalanced use of knowledge domains in the construction of clinical guidance. This constitutes an important framework to understand the interplay of participants and knowledge in guideline development. (C) 2006 Elsevier Inc. All rights reserved.