The Program in Evidence-based Care (PEBC) is an initiative of the Ontario provincial cancer system, Cancer Care Ontario (CCO), supported by the Ontario Ministry of Health and Long Term Care. The PEBC mandate is to improve the quality of cancer care and the lives of Ontarians affected by cancer, through the development, dissemination and evaluation of evidence-based guidelines and other advice documents that are designed to facilitate clinical, planning, and policy decisions about cancer control. The PEBC is based at McMaster University in Hamilton, Ontario, and is academically linked with the Department of Oncology in the Faculty of Health Sciences.
The PEBC supports a network of Guideline Development Groups (GDGs), including standing committees for specific cancers, called Disease Site Groups (DSGs), and Expert Panels that are convened to address a specific topic. All GDGs are comprised of clinicians, other health care providers and decision makers, and methodologists from across the province. The PEBC also works with the various Clinical Programs and other divisions and initiatives of CCO to identify areas where evidence-based guidance is needed.
The PEBC’s staff includes a core team of trained methodologists, the Research Coordinators, who work in partnership with the GDGs to develop evidence-based guidance on priority topics. These PEBC methodologists develop the evidence base on which guidance will be based, assist in the formulation of recommendations, and generally support the development of the PEBC documents. They are supported by the administrative, quality control, and management teams of the PEBC.
The Evidence-Based Series
The majority of PEBC documents use a common structural template, the Evidence-based Series (EBS). The EBS has a three-part modular structure:
- Guideline Recommendations - This document, which can be read independently from parts 2 and 3 highlights the guideline recommendations. It includes guideline questions and summary of key evidence underpinning the recommendations.
- Evidentary Base - This section consists of a detailed summary and analysis of the available evidence upon which the recommendations are based.
- EBS Development Methods and External Review Process - This section describes not only the general methods used by the PEBC to create the document and develop its recommendations, but also the internal and external review processes that the document has undergone and the results of that review
The impetus to begin a new PEBC guideline project may come from an existing DSG/GDG, CCO Clinical Programs or Executive Team, the Ontario Ministry of Health and Long Term Care or other stakeholders in the Ontario cancer system. Some common criteria used to set priorities include the burden of disease, emergence of new care options, unwanted variation in clinical practice, opportunity to improve quality of care, safety or system performance, and new evidence. Every PEBC project begins with a planning process, involving the project leaders and a project Working Group, and with a formal project plan document as the outcome.
Creating A Project Plan
Every PEBC project begins with a planning process, involving the project leaders and a project working group, with a formal project plan document as the outcome. The PEBC project plan is developed from a generic template that describes all the pertinent aspects of the project:
- Membership of the overall GDG that will review and take responsibility for the content of the guideline.
- Working Group members and their roles
- Topic, purpose, and scope of the project
- Methods that will be used to develop the evidence base and the recommendations
- Expected external review process for document
- Peer-reviewed publication strategy for document
- Timeline for completion of key development steps, and overall project completion
Once a project plan has been completed, the process of creating the document can begin. The document creation process will depend on the choices made during project planning, but the process can be generally divided into four stages: identification and review of existing guidelines, systematic review of the evidence, recommendations formulation, and draft completion.
Review: Internal and External
Internal: A new draft of the document incorporating previous draft recommendations is reviewed by the Report Approval Panel (RAP), whose membership includes the PEBC Director and Assistant Directors, an expert methodological consultant contracted by the PEBC for this purpose, and occasionally other methodological experts. The intent of this review is to ensure that the guideline development was methodologically rigourous and that the evidence-based recommendations are indeed supported by the evidence in a transparent way. Feedback from the RAP and the GDG is considered, and responses to the review are prepared through discussion and informal consensus by the Working Group.
External: Following the approval by the RAP and the GDG and the integration of the internal review process into Section 3, the new draft is prepared for external review. The PEBC submits its documents to two forms of external review: targeted peer review and professional consultation.
Once the results of the external review are incorporated, the document undergoes approval by the GDG. It then receives a final copy editing and is considered completed. The guideline can now be published and disseminated not only to its intended users but also to other interested parties.
Once a document has been completed, it remains available on the PEBC website until it is updated or identified as being irrelevant to practice or incorrect. Ideally, the PEBC would choose to continually update the evidence base and recommendations of all of its documents, but the reality is that there are insufficient resources to do so. The PEBC has instead implemented a process of document maintenance that prioritizes those documents most in need of review and that makes the current status, relevance, and currency of the its documents clear to the users.
Implementing the PEBC Development Cycle in other contexts
The PEBC is committed to furthering the science and practice of evidence-based guidance development both in Canada and around the world. The PEBC has a number of other tools, templates, examples, and protocols that are used by PEBC staff for training and to conduct the processes described above. While these materials are customized for our use, they may be useful to other organizations seeking to develop evidence-based guidance or implement an evidence-based guidance program, or for other purposes. We are happy to share these materials with interested parties. Please contact the PEBC, by phone at 1-905-525-9140 x 22055 or by email at ccopgi.mcmaster.ca, to obtain these materials, or to ask any questions you may have regarding this handbook, the PEBC methods, or any of our documents.