Clinical Practice Guidelines: How Much to Trust and Follow?

Clinical practice guidelines (CPGs) are aimed at guiding clinicians in making sound decisions and thus help optimize patient care. However, their development is a complex process, compromise with which can undermine the quality of the resultant CPG. The foremost risk lies in conflict of interest on part of those developing the CPG. In addition, formulation of a good-quality CPG requires balanced composition of the development panel, formulation of relevant clinical questions, use of rigorous systematic review methodology, well-defined processes for rating of evidence and grading of recommendations, complete transparency of processes, and full disclosure regarding funding and sponsorship.

This article reviews the steps in the formulation of a CPG, and various considerations that determine the quality of a CPG. It also discusses the common pitfalls in their development, and the issue of existence of multiple conflicting CPGs on the same topic, using guidelines from India on hepatocellular carcinoma published in this journal and elsewhere as an example.