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Developing clinical guidelines for end-of-life care: blending evidence and consensus.

BACKGROUND
Developing clinical practice guidelines (CPGs) is challenging, particularly in areas that are difficult to research such as end-of-life care.


AIM
To describe the process that staff in a large regional health-care service in Victoria, Australia, used to develop CPGs for managing diabetes at the end of life.


METHOD
An interdisciplinary advisory group was appointed, a structured literature review undertaken, personal illness accounts sourced, and a guiding philosophy formulated. Individual interviews were conducted with people with diabetes and their carers. Formative and summative evaluation was undertaken.


RESULTS
No level I or II evidence was identified. The interviews yielded important information about how people wanted their diabetes managed. Formative evaluation enabled stakeholders to participate in developing the CPGs. The summative evaluation confirmed the CPGs are easy to use and appropriate to clinical staff.


CONCLUSIONS
The CPG development process yielded the best current evidence on which to base care plans and person-centred CPGs.