FAQs on Guidelines
01. Are the European Breast Guidelines the new edition of European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis?
No. The GDG is not developing a new edition of any past guidelines.
The European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis (2006) were an essential tool for professionals involved in screening and diagnosis. However, there will not be a new version of these guidelines. The technical aspects included in the 2006 edition (and 2013 supplements) will not be addressed by the European Breast Guidelines, but they will be covered by other documents included in the ECIBC web-hub.
02. What do the European Breast Guidelines contain?
The European Breast Guidelines include evidence-based recommendations for screening and diagnosis of breast cancer. The Guidelines Development Group (GDG), supported by the Iberoamerican Cochrane Centre, develops the recommendations according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. More on methodology.
The European Breast Guidelines are web-based. Moreover, they have a modular approach, which allow updating each module of the guidelines as the new evidence emerges.
03. What is the meaning of a ‘strong’ or ‘conditional’ recommendation?
The European Breast Guidelines develop the recommendations with GRADE. GRADE classifies the recommendations as “strong” or “conditional” according to several factors, such as the certainty of the evidence, or the values and preferences of patients.
In strong recommendations the guideline panel is confident that the desirable effects of an intervention outweigh its undesirable effects (strong recommendation for an intervention) or that the undesirable effects of an intervention outweigh its desirable effects (strong recommendation against an intervention).A strong recommendation implies that most or all individuals will be best served by the recommended course of action (GRADE Handbook). Therefore, all healthcare professionals should follow a strong recommendation unless a clear and compelling justification for an alternative approach is extraordinarily present.
In a conditional recommendation the desirable effects probably outweigh the undesirable effects (conditional recommendation for an intervention) or undesirable effects probably outweigh the desirable effects (conditional recommendation against an intervention) but appreciable uncertainty exists.
A conditional recommendation implies that not all individuals will be best served by the recommended course of action, and that there is a need to consider more carefully than usual the individual patient’s circumstances, preferences, and values. For conditional recommendations healthcare professionals need to allocate more time to a shared decision making, making sure that they clearly and comprehensively explain the potential benefits and harms to the patient. Alternative names for “conditional” recommendations are “weak”, “discretionary”, or “qualified” recommendations (GRADE Handbook).
04. What is the methodology to develop the Guidelines’ recommendations?
The Guidelines Development Group (GDG) prepared a list of well-built questions using the PICO structure (Population, Intervention, Comparison, Outcomes). A PICO question compares the effects (Outcomes) of an action (Intervention), for example, a specific medical examination, as compared to other action (Comparison), such as doing nothing, on a determined group of people (Population), for example, women above a certain age.
For each question, the Iberoamerican Cochrane Centre reviewed all the relevant scientific literature. Based on the evidence retrieved, the GDG used Evidence-to-Decision frameworks to formulate the final recommendations. More on the methodology.
05. What will the Guidelines Platform contain?
The Guidelines Platform will include evidence-based recommendations for key breast cancer care processes after diagnosis, that is, for treatment, rehabilitation, survivorship, and palliative care. The Platform will be as inclusive and comprehensive as possible while ensuring that contains only high-quality, evidence-based guidelines.
The recommendations will be identified through frequent searches run by the Iberoamerican Cochrane Centre and through open calls for guidelines. Therefore, there will be a process in place that will allow maintaining the Platform up-to-date.
This Platform, together with the European Breast Guidelines, will provide the evidence-base to develop the requirements and indicators of the European Quality Assurance scheme for breast cancer services.
06. When will ECIBC evidence-based guidelines be available?
JRC will publish the first group of recommendations from mid-December 2016. This is the indicative planning scheduled for the releases of the recommendations:
• November 2016
• April 2017
• October 2017
• March 2018
07. Who will own the guidelines contained in the Platform?