DEVELOPING EVIDENCE-BASED CLINICAL-PRACTICE GUIDELINES - LESSONS LEARNED BY THE US PREVENTIVE SERVICES TASK-FORCE

The US Preventive Services Task Force is an expert panel established b y the federal government in 1984 to develop evidence-based practice gu idelines on screening tests and other preventive services. Its recomme ndations are published elsewhere. This article explores the lessons le arned in the process of developing and disseminating the recommendatio ns. Topics include project organization (analytic philosophy, project sponsorship, panel composition, topic selection); the review of eviden ce (selecting outcome measures for judging effectiveness, constructing ''causal pathways,'' searching the literature, rating the evidence, s ynthesizing the results); crafting recommendations (extrapolation, ass essing magnitude, balancing risks and benefits, addressing costs, deal ing with insufficient data, separating science from policy); peer revi ew; collaboration with other groups; evaluating impact on clinicians' knowledge, attitudes, and behavior; updating recommendations; and defi ning a research agenda. The lessons learned suggest potential refineme nts in the future work of the task force and other groups engaged in g uideline development.