November 02, 2017
2 min read

‘Simple, easy’ checklist helps PCPs pinpoint relevant clinical guidelines

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Allen Shaughnessy
Allen F. Shaughnessy

Researchers developed an eight-item checklist that they say helps clinicians simply and easily determine appropriate clinical practice guidelines.

The checklist, called the Guideline Trustworthiness, Relevance and Utility Scoring Tool, or G-TRUST, was published in Annals of Family Medicine.

“Tools are available to evaluate the quality of clinical practice guidelines. These tools, however, ... are difficult to use by nonresearchers without extensive training. None of these tools considers the need for a focus on patient-oriented outcomes, and none allows users to conclude whether a guideline should be followed,” Allen F. Shaughnessy, PharmD, MMedEd, a family medicine resident at the Cambridge Health Alliance at Tufts University, and colleagues wrote.

To fill in the resource gap, researchers used information gleaned from the National Academy of Medicine’s guidelines and the AGREE II tool to develop G-TRUST. Four rounds of feedback from consumer representatives, guideline developers and experts in evidence-based medicine also steered the tool’s development.

Shaughnessy and colleagues wrote that eight items, such as clarity, call to action, research material used, developers’ affiliations, and patient improvement outcomes, all of which pertain to a guideline’s relevance, evidence and interpretation, made it into G-TRUST. Using the AGREE II tool as a comparison, G-TRUST ranked guidelines as “useful,” “may not be useful” and “not useful.”

Researchers also wrote that more than 75% of the experts evaluating its effectiveness believed three of the checklist items were important indicators of guideline usefulness: guideline data is based on systematic review; guidelines rank quality of evidence; and guidelines focus on improving patient-oriented outcomes.

Shaughnessy and colleagues drew other comparisons between their tool and AGREE II.

“G-TRUST is more stringent than AGREE II in that it stipulates an independent (ie, nonconflicted) research analyst or methodologist be part of the process, based on recent research findings that including independent methodological experts may better ensure evidence-based and conservative recommendations,” Shaughnessy and colleagues wrote.

“The tool is also more stringent than AGREE II in its handling of conflicts of interest — barring them rather than simply addressing them — and in broad representation on the guideline development group,” researchers continued, saying this led G-TRUST to classify guidelines as irrelevant, that AGREE considered high-quality,” they continued.

According to researchers, clinicians have a plethora of guidelines to choose from, and not all may be reliable, thus necessitating G-TRUST.

“The eight-item G-TRUST instrument is a potentially helpful tool for clinicians to identify clinical practice guidelines that are trustworthy in their development, reliable in their application to patient care, and have high utility in clinical practice,” Shaughnessy and colleagues concluded. – by Janel Miller

For more information or to access the tool: Allen F. Shaughnessy, PharmD, MMedEd, can be reached at:

Disclosures: Shaughnessy reports previously publishing research evaluating clinical practice guidelines and a commentary advocating for more rigorous oversight of guideline development and dissemination. Please see the study for all other authors’ relevant financial disclosures.