Guideline development process

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  Cite this guideline

Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer. Sydney: Cancer Council Australia. [Version URL: http://wiki.cancer.org.au/australiawiki/index.php?oldid=152048, cited 2017 Nov 17]. Available from: http://wiki.cancer.org.au/australia/Guidelines:PSA_Testing/Guideline_development_process.

National Health and Medical Research Council These guidelines (recommendations) in the web-version of this guideline were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 2 November 2015 under section 14A of the National Health and Medical Research Council Act 1992. expand arrow

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In approving the guidelines (recommendations), NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of five years. NHMRC is satisfied that the guidelines (recommendations) are systematically derived, based on the identification and synthesis of the best available scientific evidence, and developed for health professionals practising in an Australian health care setting.

This publication reflects the views of the authors and not necessarily the views of the Australian Government.

Introduction

Prostate Cancer Foundation of Australia (PCFA) initiated the process to develop a clinical practice guideline for PSA testing and management of test-detected prostate cancer. This guideline is a collaborative project between PCFA and Cancer Council Australia.

Development began in November 2012 after NHMRC agreed to consider approving the guideline, provided it were to be developed according to NHMRC procedures and requirements. To better describe the scope of the guideline, the title was changed to Clinical practice guidelines for PSA testing and early management of test-detected prostate cancer. Financial support for the guideline project was provided by PCFA with Cancer Council Australia contributing in kind resources of their guideline development team.

Guideline development group

Following a consultation process with key stakeholders involved in cancer control and clinical care delivery, including the Urological Society of Australia and New Zealand (USANZ) and the Royal College of Pathologists of Australasia (RCPA), PCFA invited a multidisciplinary group of relevant experts to develop a clinical guideline for PSA testing and clinical care immediately following test-detected prostate cancer. This was to ensure that representatives from all specialities and disciplines involved in the diagnosis and management of prostate cancer were represented. Two consumer representatives were also invited to be part of the Expert Advisory Panel (EAP) (see Appendix 2).

PCFA and Cancer Council Australia appointed a steering committee. The Project Steering Committee was responsible for the overall management and strategic leadership of the guideline development process. The Project Steering Committee ensured that all deliverables agreed in the project plan were delivered to acceptable standards in accordance with NHMRC requirements.

A project team based at Cancer Council Australia conducted the systematic reviews, comprising of systematic literature searches, literature screening against pre-determined inclusion and exclusion criteria and critical evaluation and data extraction of the included literature. The project team was responsible for liaising with the EAP members in regards to content development and content review and compiling the document.

The clinical practice guideline was developed according to the procedures and requirements for meeting the 2011 NHMRC standard for clinical practice guidelines.[1] The development program was designed to meet the scientific rigour required by the standard for developing high quality, evidence-based clinical practice guidelines. A series of NHMRC resources and handbooks[2] [3] [4] [5] [6] [7] [8] [9] [10] guided the process and outlined the major steps and expectations involved in developing guidelines. These documents provided the definitions and protocols for developing research questions and search strategies, conducting systematic literature reviews, summarising and assessing the relevant literature and finally, formulating and grading the recommendations. They also included checklists and templates created to satisfy designated standards of quality and process.

At its initial meeting the Guidelines Expert Advisory Panel developed clinical questions. The questions were allocated to specific Guidelines Expert Advisory Panel members to act as lead authors according to their areas of expertise. Each lead author team was able to co-opt additional experts, who were not part of the Expert Advisory Panel, as co-authors for their allocated questions. These question-specific groups are referred to as Question Specific Working Parties in this guideline document. The Project Steering Committee assessed the suggestion of any additional co-authors including their declaration of interest (see Appendix 6).

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Steps in preparing clinical practice guidelines to NHMRC criteria

For every question the below steps were followed:

1. Develop a structured clinical question (PICO question)

2. Search for existing relevant guidelines and systematic reviews

3. Process if relevant clinical practice guideline was identified or not

3a If no relevant clinical practice guideline was found


Check if an existing systematic review of high quality exists and can be used to inform the systematic review process


Developing the systematic review protocol and systematic literature search strategy for each PICO question


Conducting the systematic literature search according to protocol


Screening of literature results against pre-defined inclusion and exclusion criteria


Critical appraisal and data extraction of each included article

3b If a relevant clinical practice guideline was found and assessed as suitable for adaption

Conduct systematic literature review update for the question of the existing clinical practice guideline


Screening of literature update results against pre-defined inclusion and exclusion criteria


Critical appraisal and data extraction of each new included article


Update evidence table of evidence review of existing guideline with new literature update results



4. Summarise the relevant data

5. Assess if meta-analysis should be undertaken

5a If meta-analysis is decided to be undertaken as part of the systematic review

Formulate rationale for meta-analysis

Select studies for inclusion

Extract data

Perform statistical analysis

Present results

5b No meta-analysis

Continue with step 6





6. Assess the body of evidence and formulate recommendations

7. Write the content narrative

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Developing a structured clinical question

A wide range of questions was proposed for research. The questions focused on diagnosis, prognosis, risk and interventions. All proposed questions were reviewed on the basis of their purpose, scope and clinical importance to the target audience and were structured according to the PICO (populations, interventions, comparisons, outcomes) framework (see Appendix 3). The Question Specific Working Parties provided the systematic review team with feedback to refine the PICO questions.

Search for existing relevant guidelines and systematic reviews

For each PICO question, the National Guideline Clearinghouse the [www.cancerview.ca Guidelines Resource Centre] as well as the scoping search for the PICO question were scanned for relevant clinical practice guidelines that could potentially be suitable for adaption.

If an existing guideline was identified, the guideline was assessed for adaption according to the ADAPTE process. If suitable, the guideline systematic review was adapted as outlined in Guideline adaption for PICO questions 8.1, 8.2 and 9 (NICE).

Relevant guidelines that did not meet the criteria for adaption were checked for systematic reviews that could be used as a source of relevant references to inform the systematic review process for the PICO question. Full systematic reviews were then performed as outlined in the following sections.

Developing a systematic search strategy

For each PICO question, systematic literature search strategies were developed by the technical team.

Most searches were directed to prostate cancer as a generic base. Searches were limited or widened as necessary according to the PICO structure using keywords or MESH and subject terms. Systematic search strategies were derived from these terms for each included electronic databases. The included standard databases searched were Medline, Embase, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects and Health Technology Assessment for all questions. The psychosocial questions also included CINAHL and PsycINFO databases to retrieve relevant literature.

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Conducting the systematic literature search according to protocol

Clinical practice guidelines should be based on systematic identification and synthesis of the best available scientific evidence.[2] For each clinical question, that required a systematic literature review, literature searches were conducted systematically with the literature cut-off date of 1 March 2014. The following electronic databases were part of the systematic literature search strategy:

  • Medline: bibliographic references and abstracts to articles in a range of languages on topics such as clinical medical information and biomedicine, and including the allied health fields, biological and physical sciences
  • EMBASE: major pharmacological and biomedical database indexing drug information from 4550 journals published in 70 countries
  • Database of Abstracts of Reviews of Effects and Health Technology Assessment: contains details of systematic reviews that evaluate the effects of healthcare interventions and the delivery and organisation of health services
  • The Cochrane Database of Systematic Reviews: contains systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care
  • CINAHL: bibliographic references and abstracts to journal articles, book chapters, pamphlets, audiovisual materials, software, dissertations, critical paths, and research instruments on topics including nursing and allied health, biomedicine, consumer health, health sciences librarianship, behavioural sciences, management and education
  • Psychinfo: bibliographic references and abstracts to journal articles, book chapters, dissertations and technical reports on psychology; social, clinical, cognitive and neuropsychology; psychiatry, sociology, anthropology and education, with source material from a wide range of languages.

A search filter to retrieve relevant literature considering Aboriginal and Torres Strait Islander peoples was added to each question.

Additional relevant papers from reference lists and, where appropriate, clinical trial registries, were also identified for retrieval as part of the snowballing process.

The full detailed systematic literature search strategy for every clinical question is fully documented in the technical report of the question (see Technical report.

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Screening of literature results against pre-defined inclusion and exclusion criteria

Part of the systematic review process is to screen all retrieved literature results against the pre-defined inclusion and exclusion criteria in two stages.

a) First screen

During the first screening round, the titles and abstracts of all retrieved literature were screened by one or two reviewers. All irrelevant, incorrect and duplicates were removed.

b) Second screen

A second screen was undertaken based on the full article. Two reviewers assessed each article for inclusion against the pre-defined inclusion and exclusion criteria for each question. In the case of a disagreement between the reviewers, a third independent reviewer assessed the article against the inclusion and exclusion criteria. Articles that met the inclusion criteria were forwarded for quality assessment and data extraction.

Critical appraisal and data extraction of each included article

Two assessors independently assessed the risk of bias of each of the included studies using a study design specific assessment tool and where necessary pre-specified criteria (see Technical report) for all quality assessment tools). Any disagreements were adjudicated by a third reviewer.

For all included articles, the relevant data was extracted and summarised in study characteristics and evidence tables. Each data extraction was checked by a second assessor. These tables are included in the technical report for each question (see Technical report.)

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Guideline adaption for PICO questions 8.1, 8.2 and 9 (NICE)

For clinical questions 8.1, 8.2, and 9 (NICE), the National Institute for Health and Care Excellence (NICE) guideline[11] for the management of prostate cancer was identified as potentially relevant and were assessed for potential adaption. The ADAPTE process[12] (particularly steps 2.2-2.5) was followed to establish if the guidelines were suitable for adaption.

To be considered for adaptation or adoption for this guideline, an existing guideline must:

  • be assessed using the AGREE instrument for the domains rigour, clarity and editorial independence
  • score at least 70% for each of these domains
  • address PICO question(s) sufficiently similar to the PICO question(s) asked by the relevant working party (i.e. Do the recommendation(s) answer our question(s)?).

In the first instance, the NICE guidelines were assessed by four independent assessors using the three domains: rigour of development, clarity of presentation and editorial independence of the AGREE II instrument. The NICE guidelines scored 84.4% in the domain rigour of development, 76% in the domain clarity of presentation and 85.4% in the domain of editorial independence. The lead authors for PICO questions 8.1, 8.2 and 9 (NICE) were then approached by the systematic review team to verify that the PICO question addressed in the existing NICE guideline was suitable and relevant.

The systematic review team then updated the NICE systematic reviews to 1 March 2014 for the questions to be adapted. The literature was searched using the NICE literature search strategies and the results were screened against inclusion and exclusion derived from the NICE evidence review (see Screening of literature results against pre-defined inclusion and exclusion criteria). Included studies were assessed for quality and data extraction (see Critical appraisal and data extraction of each included article). The evidence tables from the NICE guidelines were updated with the study results from the updated literature review and included in the technical report for the relevant PICO question. The term “Updated Nice systematic review” is used in the narrative of these guideline questions to refer to the studies identified in the literature update of the NICE systematic review.

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Meta-analysis for clinical question 7

For clinical question 7, a meta-analysis was conducted as part of the systematic review. The meta-analysis rationale was formulated. The relevant data was extracted from the studies included in the systematic review. The statistical analysis was conducted and the results presented. The analysis used logistic regression with generalised estimating equation adjustment to account for multiple (sometimes one but mostly two or more) biopsy components analysed from each man (using the patient identifier as the panel variable). The technical report for this question details the steps followed and includes the meta-analysis results.

Summary of the relevant data

For each outcome examined, the results, level of the evidence, the risk of bias due to study design, and the relevance of the evidence for each included study were documented a body of evidence table.

Each question was addressed by a systematic review resulting in a systematic review report. All systematic review reports are published in the technical report of the guidelines. Levels of evidence are shown below.

Table 1 . Designations of levels of evidence according to type of research question (NHMRC, 2009)

Level Intervention Diagnosis Prognosis Aetiology Screening
I A systematic review of level II studies A systematic review of level II studies A systematic review of level II studies A systematic review of level II studies A systematic review of level II studies
II A randomised controlled trial A study of test accuracy with: an independent, blinded comparison with a valid reference standard, among consecutive patients with a defined clinical presentation A prospective cohort study A prospective cohort study A randomised controlled trial
III-1 A pseudo-randomised controlled trial (i.e. alternate allocation or some other method) A study of test accuracy with: an independent, blinded comparison with a valid reference standard, among non-consecutive patients with a defined clinical presentation All or none All or none A pseudo-randomised controlled trial (i.e. alternate allocation or some other method)
III-2 A comparative study with concurrent controls:

Non-randomised, experimental trial

Cohort study

Case-control study

Interrupted time series with a control group

A comparison with reference standard that does not meet the criteria required for Level II and III-1 evidence Analysis of prognostic factors amongst untreated control patients in a randomised controlled trial A retrospective cohort study A comparative study with concurrent controls:

Non-randomised, experimental trial

Cohort study

Case-control study

III-3 A comparative study without concurrent controls:

Historical control study

Two or more single arm study

Interrupted time series without a parallel control group

Diagnostic case-control study A retrospective cohort study A case-control study A comparative study without concurrent controls:

Historical control study

Two or more single arm study

IV Case series with either post-test or pre-test/post-test outcomes Study of diagnostic yield (no reference standard) Case series, or cohort study of patients at different stages of disease A cross-sectional study Case series

Source: National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC; 2009. (https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf)

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Assess the body of evidence and formulate recommendations

The technical report for each question was forwarded to each question-specific author team. The author teams in collaboration with the systematic review team (who conducted the systematic reviews and provided the technical reports) assessed the body of evidence and completed the NHMRC Evidence Statement form to record the volume of the evidence, its consistency, clinical impact, generalisability and applicability and developed evidence statements (see Technical report.) The process is described in NHMRC additional levels of evidence and grades for recommendations for developers of guidelines (2009).[10]

Following grading of the body of evidence and development of evidence statements, expert authors were asked to formulate evidence-based recommendations that related to the summarised body of evidence. The method of grading recommendations is shown in Table 2.

Table 2: Grading of recommendations

Component of Recommendation Recommendation Grade
A

Excellent

B

Good

C

Satisfactory

D

Poor

Volume of evidence 1** one or more level I studies with a low risk of bias or several level II studies with a low risk of bias one or two level II studies with a low risk of bias or a systematic review/several level III studies with a low risk of bias one or two level III studies with a low risk of bias, or level I or II studies with a moderate risk of bias level IV studies, or level I to III studies/systematic reviews with a high risk of bias
Consistency 2** all studies consistent most studies consistent and inconsistency may be explained some inconsistency reflecting genuine uncertainty around clinical question evidence is inconsistent
Clinical impact very large substantial moderate slight or restricted
Generalisability population/s studied in body of evidence are the same as the target population for the guideline population/s studied in the body of evidence are similar to the target population for the guideline population/s studied in body of evidence differ to target population for guideline but it is clinically sensible to apply this evidence to target population3 population/s studied in body of evidence different to target population and hard to judge whether it is sensible to generalise to target population
Applicability directly applicable to Australian healthcare context applicable to Australian healthcare context with few caveats probably applicable to Australian healthcare context with some caveats not applicable to Australian healthcare context

1 Level of evidence determined from level of evidence criteria

2 If there is only one study, rank this component as ‘not applicable’

3 For example results in adults that are clinically sensible to apply children OR psychosocial outcomes for one cancer that may be applicable to patients with another cancer.

**For a recommendation to be graded A or B, the volume and consistency of evidence must also be graded either A or B!

Source: National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC; 2009. (https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf)
The overall recommendations grade are shown in table 3.

Table 3: Overall recommendation grades

Grade of recommendation
Description
A
Body of evidence can be trusted to guide practice
B
Body of evidence can be trusted to guide practice in most situations
C
Body of evidence provides some support for recommendation(s) but care should be taken in its application
D
Body of evidence is weak and recommendation must be applied with caution

Source: National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC; 2009. (https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf)

In addition to developing evidence-based recommendations as a result of the systematic review for a question, expert authors could also draft consensus-based recommendations in the absence of evidence after having performed a systematic review or practice points, when a matter was outside the scope of the search strategy for the systematic review. The NHMRC approved recommendation types and definitions are shown in table 4.

Table 4: NHMRC approved recommendation types and definitions

Type of recommendation
Definition
Evidence-based recommendation
A recommendation formulated after a systematic review of the evidence, indicating supporting references
Consensus-based recommendation
A recommendation formulated in the absence of quality evidence, after a systematic review of the evidence was conducted and failed to identify admissible evidence on the clinical question
Practice point
A recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process


Source: National Health and Medical Research Council. Procedures and requirements for meeting the NHMRC standard for clinical practice guidelines. Melbourne: National Health and Medical Research Council, 2011


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Writing the content

For each question, the assigned lead authors were asked to draft their guideline chapter using the following format:

  • general introduction to the clinical question
  • background to the clinical question, including its clinical importance and historical evidence, where relevant
  • review of the evidence, including the number, quality and findings of studies identified by the systematic review
  • evidence summary in tabular form including evidence statements, levels of evidence of included studies, and reference citations
  • evidence-based recommendation(s) and corresponding grade(s), consensus-based recommendations and practice points
  • implications for implementation of the recommendations, including possible effects on usual care, organisation of care, and any resource implications
  • discussion, including unresolved issues, relevant studies currently underway, and future research priorities
  • references.

The content draft was then reviewed by all Question Specific Working Party members. The draft documents underwent several iterations until agreement between the members of the Question Specific Working Parties on these drafts was reached.

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Review of the draft chapters

The complete draft guideline document with all draft chapters was circulated to the Guidelines Expert Advisory Panel. The whole group was asked to review the content and submit feedback. Members were asked to submit further suggestions on consensus-based recommendation and practice points.

A face-to-face meeting with all Expert Advisory Panel members was held to review and finalise the draft guidelines for public consultation. Prior to this meeting, the latest iteration draft guidelines were circulated. All panellists were asked to review the content, individual recommendations and practice points in detail, and to identify and note any controversies and points to be discussed at the group meeting. During the meeting, each recommendation and practice point was tabled as an agenda point. Each was reviewed and approved by consensus, which was reached by voting. The Expert Advisory Panel Chairperson nominated a particular recommendation/practice point to be reviewed and the panellists had the opportunity to discuss any issues and suggest revisions to recommendations and practice points. Each recommendation and practice point was approved once the eligible panellists (excluding representatives of the funding bodies and panellists who cannot vote due to conflict of interest) have reached consensus.

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Public consultation

A complete draft of the guideline was sent out for public consultation from 4 December 2014 to 16 January 2015. The public consultation of the guideline was launched at the joint meeting day of the Union for International Cancer Control (UICC) World Cancer Congress and the Clinical Oncology Society of Australia (COSA) Annual Scientific meeting held on 4 December 2014 in Melbourne. The aim of this was to give the draft guidelines significant exposure to the international as well as the Australian cancer community. Submissions were invited from the general public and professional societies and groups and other relevant stakeholders. The consultation was publicised by advertisement in a national newspaper, and by contacting professional societies and groups, consumer groups and other relevant stakeholders.

All feedback on the draft received during the consultation period in Australia was compiled and sent to the relevant Question Specific Working Party to review their draft content, assessing and considering the submitted comments. Each additional submitted paper during public consultation was be assessed by the methodologist team against the systematic review protocol. Another face-to-face meeting was organised amongst the EAP to review all public consultation comments and the amended content. Subsequent changes to the draft were agreed by consensus, based on consideration of the evidence. The same consensus process that was followed during the face to face EAP meeting prior to public consultation was followed again. All changes resulting from the public consultation submission reviews were documented and made accessible once the guidelines are published.

A final independent review of experts in their fields was conducted before the final draft was submitted to NHMRC Council. Any further suggestions by the independent expert reviewers will be integrated in the final draft and then submitted to NHMRC Council for approval.

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Organisations formally endorsing the guidelines

The following medical colleges and professional bodies were approached to endorse the guideline:

  • Australian College of Rural and Remote Medicine (ACRRM)
  • Medical Oncology Group of Australia Incorporated (MOGA)
  • Royal College of Pathologists of Australia (RCPA)
  • Royal Australian College of Physicians (RACP) - Adult Health Division
  • Royal Australian College of Physicians - Australian Chapter of Palliative Medicine (AChPM, RACP)
  • Royal Australian College of Physicians - Australian Faculty of Public Health Medicine (AFPHM, RACP)
  • Royal Australian College of Surgeons (RACS)
  • Royal Australian College of General Practitioners (RACGP)
  • Royal Australian and New Zealand College of Radiologists (RANZCR)
  • Urological Society of Australia and New Zealand (USANZ).

Formal endorsement of the guidelines was granted from:

  • Australian College of Rural and Remote Medicine (ACRRM)
  • Royal College of Pathologists of Australia (RCPA)
  • Royal Australian College of General Practitioners (RACGP)
  • Royal Australian and New Zealand College of Radiologists (RANZCR)
  • Urological Society of Australia and New Zealand (USANZ).

Dissemination and implementation

PCFA and Cancer Council Australia will take the lead in disseminating the guideline in Australia and are following a multi-strategy approach for the dissemination and implementation of the guideline, as this has shown to positively influence guideline uptake.[13] [14]

This will include a campaign to raise awareness of the new guidelines that incorporates organised media coverage through multiple outlets and an official launch at an international conference. The guideline will be distributed directly to relevant professional and other interested groups and through meetings, national and international conferences, and other professional development and continuing medical education (CME) events. A significant effort will be made to have the guideline introduced to senior undergraduate medical students and to encourage the relevant learned colleges to support the guideline and to foster their integration into hospital and community practice through resident and registrar education activities.

The guideline will be made available as a print publication, which can be ordered from PCFA and Cancer Council Australia. In addition, the guideline will also be made available as an online guideline via the Cancer Council Australia Cancer Guidelines Wiki. The online guideline version increases availability as well as accessibility, and usage will be tracked and analysed with a web analytics solution. Interlinking and listing the guidelines on national and international guideline portal is an important part of the digital dissemination strategy. Important Australian health websites, such as EviQ and healthdirect Australia will be approached to link to the online guideline. The guideline will also to be listed on national and international guideline portals such as Australia’s Clinical Practice Guidelines Portal, Guidelines International Network guidelines library and National Guidelines Clearinghouse. The Cancer Guidelines Wiki is a responsive website that is optimised for mobile and desktop access. When accessing the guidelines with a mobile and tablet device, an icon can be easily added to the homescreen of mobile devices, offering easy mobile access.

In addition, the final guideline document will be launched via email alert to professional organisations, interested groups and clinical experts in the field, directing them via URL link to the online guideline and all associated resources. Future promotion will be conducted through print and social media campaigns as well as disseminating the guideline through further meetings, national and international conferences and other CME events. Local expert leaders will be identified and approached to facilitate dissemination and act as champions for the guidelines.

As part of the online guideline, online learning modules are planned to be developed to reinforce the guidelines content knowledge for participants, thus support guideline implementation and uptake. Programs will be developed using QStream (http://qstream.com/company/brain-science), a clinically proven online education method that was originally developed by Harvard Medical School. QStream programs have shown to improve knowledge acquisition in a number of randomised trials with medical practitioners.[15] [16] [17] [18][19] [20]

The Cancer Guidelines Wiki is based on semantic web technology, so the guidelines are available in a machine-readable format, which offers the possibility to easily integrate the guideline content with systems and web applications used in the Australian healthcare context.

Use of the guidelines as part of core curriculum in specialty exams will be encouraged. It is recognised that a planned approach is necessary to overcome specific barriers to implementation in particular settings and to identify appropriate incentives to encourage uptake of guideline recommendations. Implementation of the guidelines will require a combination of effective strategies and may include further CME initiatives and interactive learning, the development and promotion of computer-assisted decision aids and electronic decision-support systems, and the creation of audit and other clinical tools.

To support the implementation of this guideline a decision aid for men considering having a PSA test, and men who have had a positive PSA test result and are considering watchful waiting or active surveillance instead of immediate treatment are going to be developed.

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Future updates

The incoming literature updates will continue to be monitored for each systematic review question. If there is strong evidence emerging in a specific area of PSA testing, the Expert Advisory Panel will be reconvened to assess if this warrants a guideline update (full or partly). It is recommended that these guidelines be updated after 3 years.

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References

  1. National Health and Medical Research Council. Procedures and requirements for meeting the NHMRC standard for clinical practice guidelines. Melbourne; 2011.
  2. 2.0 2.1 National Health and Medical Research Council. A guide to the development, evaluation and implementation of clinical practice guidelines. Commonwealth of Australia: National Health and Medical Research Council; 1999 Jan 1 Abstract available at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp30.pdf.
  3. National Health and Medical Research Council. How to review the evidence: Systematic identification and review of scientific literature. Canberra: National Health and Medical Research Council; 1999 Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp65.pdf.
  4. National Health and Medical Research Council. How to prepare and present evidence-based information for consumers of health services: A literature review. Commonwealth of Australia: National Health and Medical Research Council; 1999 Jan 1 Abstract available at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp72.pdf.
  5. National Health and Medical Research Council. How to present evidence for consumers: Preparation of consumer publications. Canberra: Commonwealth of Australia; 1999.
  6. National Health and Medical Research Council. How to put evidence into practice: Implementation and dissemination strategies. Commonwealth of Australia: National Health and Medical Research Council; 2000 Jan 1 Abstract available at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp71.pdf.
  7. National Health and Medical Research Council. How to use the evidence: assessment and application of scientific evidence. Commonwealth of Australia: National Health and Medical Research Council; 2000 Jan 1 Abstract available at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp69.pdf.
  8. National Health and Medical Research Council. How to compare the costs and benefits: evaluation of the economic evidence. Commonwealth of Australia: National Health and Medical Research Council; 2001 Jan 1 Abstract available at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp73.pdf.
  9. National Health and Medical Research Council. Using socioeconomic evidence in clinical practice guidelines. NHMRC 2002 Abstract available at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp89.pdf.
  10. 10.0 10.1 National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Canberra; 2009 Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf.
  11. National Collaborating Centre for Cancer. Prostate cancer: diagnosis and treatment. London (UK): National Institute for Health and Care Excellence; 2014 Jan. Report No.: Clinical guideline; no. 175. Available from: http://www.nice.org.uk/guidance/cg175/chapter/the-guideline-development-group-national-collaborating-centre-and-nice-project-team.
  12. The ADAPTE Collaboration. The ADAPTE Process. Resource Toolkit for Guideline Adaptation.; 2009. Report No.: version 2.0. Available from: http://www.g-i-n.net/document-store/working-groups-documents/adaptation/adapte-resource-toolkit-guideline-adaptation-2-0.pdf.
  13. National Institute of Clinical Studies. Do guidelines make a difference to health outcomes?; 2006 Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/nics/material_resources/Do%20guidelines%20make%20a%20difference%20to%20health%20care%20outcomes.pdf.
  14. Francke AL, Smit MC, de Veer AJE, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review. BMC Med Inform Decis Mak 2008;8, (38).
  15. Kerfoot BP, Baker HE, Koch MO, Connelly D, Joseph DB, Ritchey ML. Randomized, controlled trial of spaced education to urology residents in the United States and Canada. J Urol 2007 Apr;177(4):1481-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17382760.
  16. Kerfoot BP, DeWolf WC, Masser BA, Church PA, Federman DD. Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial. Med Educ 2007 Jan;41(1):23-31 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17209889.
  17. Kerfoot BP, Armstrong EG, O'Sullivan PN. Interactive spaced-education to teach the physical examination: a randomized controlled trial. J Gen Intern Med 2008 Jul;23(7):973-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18612727.
  18. Kerfoot BP. Learning benefits of on-line spaced education persist for 2 years. J Urol 2009 Jun;181(6):2671-3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19375095.
  19. Kerfoot BP, Kearney MC, Connelly D, Ritchey ML. Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial. Ann Surg 2009 May;249(5):744-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19387336.
  20. Kerfoot BP, Brotschi E. Online spaced education to teach urology to medical students: a multi-institutional randomized trial. Am J Surg 2009 Jan;197(1):89-95 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18614145.

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