Endorsement of clinical practice guidelines: Criteria from the College of Family Physicians of Canada.

OBJECTIVE: To refine the process for endorsement of guidelines and establish the expectations of the College of Family Physicians of Canada (CFPC) regarding the quality and relevance of clinical practice guidelines targeting family physicians and their patients. COMPOSITION OF THE COMMITTEE: Initially, a group of 6 CFPC staff and selected College members reviewed the previous process for endorsement with the aim of providing a new direction, if needed. The work was then assumed by the Guideline and Knowledge Translation Expert Working Group, a purposefully selected group of 9 family physicians from across Canada with expertise in research, evidence, guidelines, knowledge translation, and continuing professional development and education. METHODS: The initial task force reviewed the endorsement process and identified areas for improvement. A draft new process and core criteria for high-quality guidelines were developed. This was approved by the CFPC board. A Guideline and Knowledge Translation Expert Working Group was then formed to further refine the process and the criteria. Multiple resources were used to inform the criteria. The Guideline and Knowledge Translation Expert Working Group will manage the endorsement process of external submitted guidelines, as well as provide high-level guidance to the CFPC regarding in-house guidelines and continuing professional development content. REPORT: This article provides the expectations of the CFPC regarding clinical practice guidelines and describes in detail the process and criteria for endorsement. Key principles include family physician involvement and guideline funding unlikely to introduce bias, with most criteria falling under 4 themed areas: relation to family medicine, CFPC values, patient engagement and decision making, and scientific rigour. The Guideline and Knowledge Translation Expert Working Group will report to the CFPC board at least once a year. It is hoped that this fully transparent process and these criteria will help advance the quality and standards of clinical practice guideline production in Canada. CONCLUSION: A comprehensive but reasonable list has been provided that reflects the best standards and recommendations and is consistent with the CFPC's values while recognizing the landscape of guideline development for its national partners and colleagues. As with all processes, careful consideration and evaluation will be essential.

Validation des lignes directrices de pratique clinique: Critères du Collège des médecins de famille du Canada.

OBJECTIF: Parfaire le processus de validation des lignes directrices et établir les attentes du Collège des médecins de famille du Canada (CMFC) quant à la qualité et à la pertinence des lignes directrices de pratique clinique à l'intention des médecins de famille et de leurs patients. COMPOSITION DU COMITÉ: Au départ, un groupe de 6 personnes, employés et membres choisis du CMFC, ont révisé le précédent processus de validation dans le but de lui donner une nouvelle orientation, au besoin. Le Groupe de travail d'experts sur les lignes directrices et le transfert des connaissances a ensuite pris le relais; ce groupe est composé de 9 médecins de famille sélectionnés avec soin partout au Canada qui sont expérimentés dans les domaines de la recherche, des données probantes, des lignes directrices, du transfert des connaissances, ainsi que du perfectionnement professionnel continu et de l'éducation. MÉTHODOLOGIE: Le groupe de travail initial s'est penché sur le processus de validation et a relevé les domaines pouvant être améliorés. L'ébauche d'un nouveau processus et de critères fondamentaux pour des lignes directrices de bonne qualité a été rédigée et approuvée par le Conseil d'administration du CMFC. Un Groupe de travail d'experts sur les lignes directrices et le transfert des connaissances a ensuite été formé pour peaufiner davantage le processus et les critères. Les critères s'appuient sur plusieurs ressources. Le Groupe de travail d'experts sur les lignes directrices et le transfert des connaissances aura la responsabilité de gérer le processus de validation des lignes directrices externes soumises, ainsi que de fournir au CMFC des conseils de haut niveau sur les lignes directrices internes et le contenu du perfectionnement professionnel continu. RAPPORT: Cet article présente les attentes du CMFC en matière de lignes directrices de pratique clinique, et décrit en détail le processus et les critères de validation. Les principes fondamentaux sont la participation des médecins de famille et le financement des lignes directrices qui est peu susceptible d'introduire un biais, et la plupart des critères s'inscrivent sous 4 thèmes : la relation avec la médecine familiale; les valeurs du CMFC; l'engagement et la prise de décision des patients; et la rigueur scientifique. Le Groupe de travail d'experts sur les lignes directrices et le transfert des connaissances présentera ses résultats au Conseil d'administration du CMFC au moins une fois l'an. L'on souhaite que ce processus complètement transparent et ces critères fassent progresser la qualité et les normes qui régissent la production des lignes directrices de pratique clinique au Canada. CONCLUSION: Une liste exhaustive, mais raisonnable, reflète les meilleures normes et recommandations, et respecte les valeurs du CMFC tout en reconnaissant le contexte de rédaction des lignes directrices pour ses partenaires et ses collègues à l'échelle nationale. Comme c'est le cas pour tous les processus, l'examen et l'évaluation approfondis seront essentiels.

The dying, those who care for them, and how they cope with loneliness.

This study compares the manner in which the dying, their caregivers, and the general population cope with loneliness. The patients were recruited in an oncological hospice in Israel and, despite being on their deathbed, agreed to participate. Thirty-seven cancer-stricken patients, 78 caregivers, and 128 participants From the general population volunteered to take part. The participants anonymously answered a 34-item questionnaire and were asked to endorse those items that described their strategies oF successFully coping with loneliness. Results suggested the dying patient, his or her caregiver, and the general population cope with loneliness diFFerently. Dying patients scored signiFicantly lower than the general population on the social support network and increased activity sub-scales, with a reversed trend For religion and Faith. This may be the First study to examine the manner in which the dying and their caregivers cope with loneliness. Thus, more research is needed to replicate the study using larger samples.

The loneliness experience of the dying and of those who care for them.

OBJECTIVE: The study compared the qualitative aspects of the loneliness experience of the dying, their caregivers, and the general population. METHOD: The patients were recruited in an oncological hospice in Israel, and, despite being on their deathbed, agreed to participate in the study. Thirty-seven cancer-stricken patients, 78 caregivers, and 128 participants from the general population volunteered to partake in the study. They answered, anonymously, a 30-item questionnaire and were asked to endorse those items that described their experience of loneliness. RESULTS: Results suggested that the three populations did, indeed, differ in their experience of loneliness. More specifically, dying patients and their caregivers had significantly higher subscale scores on the Growth and Discovery and the Self-alienation subscales than the general population did. It was also found that the number of hospitalization days was significantly negatively correlated to the Emotional Distress and Self-alienation subscales. SIGNIFICANCE OF RESULTS: The present results indicate that loneliness is experienced differently in or out of the hospice and by the dying patient, his or her caregiver, and the general population. This may be the first study to examine the qualitative aspects of the loneliness experienced by the dying and by their caregivers. More research is needed to replicate the present study, using larger samples.