Recommendation

For ‘strong’ recommendations on interventions that ‘should’ be used, the guideline development group is confident that, for the vast majority of people, the intervention (or interventions) will do more good than harm. For ‘strong’ recommendations on interventions that ‘should not’ be used, the guideline development group is confident that, for the vast majority of people, the intervention (or interventions) will do more harm than good.

For ‘conditional’ recommendations on interventions that should be ‘considered’, the guideline development group is confident that the intervention will do more good than harm for most patients. The choice of intervention is therefore more likely to vary depending on a person’s values and preferences, and so the healthcare professional should spend more time discussing the options with the patient.

To develop this guideline, an evidence review was conducted for each key question. Where studies were too limited to support an evidence-based conclusion, the guideline development group used their clinical expertise to develop consensus statements, which were then voted on using a modified Delphi process.

The Delphi process The consensus recommendations (marked by C) in this guideline were developed by a multidisciplinary group of practising healthcare professionals and patient and public representatives using a modified Delphi process. The Delphi process is a methodology designed to reach a group opinion or consensus without the drawbacks inherent within a face-to-face group process. Delphi has been shown to be more accurate than focus groups, conferences, group discussions and other traditional interactive group processes.³³ The modified Delphi process used was a multistaged survey with feedback of group results at each stage in the process. Consensus was deemed to have been reached when 70% of the group either agreed or disagreed on a question.

Recommendations based on the evidence review are marked E, while those based on the consensus process are marked C.

Good practice point

Recommended best practice based on the clinical experience of the guideline development group.