ASTROnews: ASTRO develops new committee, subcommittee to oversee guideline development
An interview with Clinical Affairs and Quality committee chair, Carol A. Hahn, M.D., and vice-chair, Benjamin D. Smith, M.D., by Shari Siuta, senior research analyst
Clinical practice guidelines are systematically developed statements to assist practitioners and patients in decisions about appropriate healthcare for specific clinical circumstances. Well-developed guidelines can enhance the appropriateness of clinical practice, improve the quality of care, lead to better patient outcomes, improve cost effectiveness and identify areas of further research needs.
In June 2009, ASTRO’s Board of Directors approved the formation of the Clinical Affairs and Quality Committee (CAQC) to develop, coordinate and provide oversight of ASTRO’s quality activities. The committee also advocates for quality initiatives within ASTRO and collaborates with external organizations regarding quality initiatives designed to improve cancer patients’ care.
The Guidelines Subcommittee was consequently developed and is housed under the CAQC. Carol A. Hahn, M.D., was appointed chair of this committee and Benjamin D. Smith, M.D., was appointed vice-chair. Prior to this restructure, guidelines were one of the missions of the Health Services Research Committee (HSRC).
Hahn and Smith spoke with ASTROnews about their vision for what this guideline initiative can do for the future of ASTRO.
Why are guidelines important?
Dr. Smith: Guidelines provide physicians with guidance for applying the most current and up-to-date evidence into their clinical practice. They help to connect evidence that is emerging with the patient care that is occurring on a daily basis. Guidelines are a method by which patients can be informed of standards of care. They are also a way to advocate for the promotion of evidence-based and state-of-the-art care for patients.
Dr. Hahn: Guidelines can serve as a baseline of quality for physicians to start their approach to an individual clinical situation. A synthesis of the highest quality evidence as well as expert opinion can be extremely useful to practicing clinicians to ensure that their interpretation of the data is accurate and complete and that their therapeutic recommendations are consistent with those who have specific expertise in a particular area. This protects the safety of the patient, especially given the wealth of literature available, which is rapidly changing, particularly in areas of clinical controversy.
How will the movement of guidelines out of HSRC and into CAQC impact guideline development?
Dr. Hahn: As chair of HSRC, I have been working on formulating a guideline process and initiating the production of documents. Guideline projects are time-consuming and involve significant time and effort by ASTRO volunteers and staff. Moving guidelines into CAQC will facilitate the expansion of guideline efforts by having a group of dedicated volunteers and staff to focus on this work. In addition, the movement into CAQC will facilitate developing ASTRO guidelines in conjunction with ASTRO’s other quality efforts.
How do you think this new focus on guideline development will impact the future of radiation oncology?
Dr. Smith: Guidelines will help to spur on the field of radiation oncology to ground its treatment recommendations firmly in evidence that has been developed over the years. Guidelines will help us move away from treatment based on personal experience and anecdotal information and move toward treatment based on well-executed clinical trials. Guidelines will bring data to light, provide an interpretive framework and improve the convenience of treatments we offer to patients.
Dr. Hahn: Guidelines can also help define areas of clinical controversy that will benefit from additional research. In convening content experts with a focused review of literature in a specific area, we can identify areas where gaps exist in the data to define the optimal treatment option for individual subgroups of patients with the goal of continuing to improve upon care.
Where will the new Guidelines Subcommittee focus its efforts?
Dr. Hahn: To date, we have been utilizing the expertise within the Health Services Research Committee to begin the guideline process and to establish projects. Going forward, we need to better define the topic selection process. We plan to look systematically through various disease sites in radiation oncology to identify the most important areas that would have the greatest benefit from evidence-based guidelines and provide evidence-based recommendations to the ASTRO membership. We are also developing processes to keep these guidelines updated. It is important that ASTRO collaborate with other societies to improve their scope and acceptance by our colleagues in other subspecialties. These efforts may serve to raise the stature of radiation oncology across various subspecialties of oncology; to work with groups, such as medical oncology, who already have established guideline processes but variably reflect and address specific issues of interest to radiation oncologists.
Dr. Smith: I would like to see guidelines become an important component of the material we offer to the membership as well as the general public. I would like to see guidelines play a more prominent role in the ASTRO Web site and ASTRO communications. It would be great to have a link on the front page of the Web site where you could see a listing of all guidelines completed by ASTRO committees, an abstract and information on how to obtain the full text of the guideline documents.
What would you say are some of the rewards or benefits of working on a guideline panel?
Dr. Smith: Participating on a guideline panel provides an opportunity to freshly review all published evidence on a particular clinical topic, which is very enlightening. It provides the development of collaborative relationships with other experts in this country as well as other parts of the world. The process of arriving at consensus is an attractive challenge that encourages an open mind. It also allows you to view issues from different perspectives and to seek a common ground. Being part of a guideline panel has been one of the most rewarding experiences of my professional life to date.
Dr. Hahn: It is very interesting to hear experts discuss areas of clinical controversy in a data driven manner. You hear the viewpoints of different experts who are all looking at the same data and at times reaching different conclusions on specific areas of clinical recommendations. Our goal with the guideline panels is to provide balance in these recommendations. By our process specifically, we want to include representatives from the community in private practice as well as in academic institutions, resident representatives and experts in physics, radiobiology and other subspecialties (as appropriate) to attempt to review all topics in a comprehensive, data driven manner. Conflicts of interest are also vetted for all panel members, and the documents are reviewed by content expert reviewers and posted on the ASTRO Web site for open comment from the membership prior to publication.
Guidelines are important educational tools for the Society and provide our members with evidence-based expert opinions on individual treatment topics. We want to roll guidelines into other educational aspects of ASTRO, such as maintenance of certification. Guidelines will also hopefully serve the Society well by providing data to support our ongoing reimbursement issues, which in turn will provide our patients with the optimal care necessary for their overall cancer therapy. If we don’t have data to support the benefit of a particular mode of radiotherapy, our hope is that the recognition of this will promote and guide the studies necessary to demonstrate benefits where they truly exist. Hopefully, ASTRO’s evidence-based guidelines will help the membership chart their own future to develop and promote the delivery of radiotherapy that is optimal to serving our patients.
Dr. Hahn is a Butler-Harris assistant professor of radiation oncology at Duke University Medical Center in Durham, N.C., and medical director of radiation oncology at Duke Health Raleigh Hospital in Raleigh, N.C. Dr. Smith is chief of radiation oncology at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio.
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