Experience of Myeloproliferative Neoplasms Guidelines in the United Kingdom: Perspective and International Context
Authors: Mary Frances McMullin, Claire Harrison
Journal: Journal of the National Comprehensive Cancer Network (2016)

The hematology community in the United Kingdom has an established process for identifying the need for a guideline and then producing and disseminating it.The British Committee for Standards in Haematology (BCSH) was formed in 1964, with the first published guideline in 1984.The resultant library of documents includes guidelines on aspects of laboratory practice, from areas such as blood transfusion to highly complex clinical management.These guidelines are published in peer-reviewed journals but are also available via a Web-based platform with free access (http://www.bcshguidelines.com).This article discusses the process and history of the production of these guidelines, with particular reference to those for myeloproliferative neoplasms (MPNs). The BCSH Guideline ProcessAlthough formed in 1964, after various negotiations, the BCSH became a subcommittee of the British Society for Haematology (BSH) in 1976.BCSH has been producing guidance for hematologists since the first guideline was published in 1984.The guidelines were initially focused on laboratory practice guidelines, but subsequently moved into areas of clinical practice.The primary aim of the BCSH guideline process is to provide hematologists with up-to-date advice on the diagnosis and treatment of hematologic disease.The BCSH process or methodology for guideline production has evolved over the years.Laboratory guidelines were mainly methodologically based, but clinical guidelines review literature, and access and grade evidence using a standardized process.Currently, 4 BCSH task forces review general hematology, hemostasis and thrombosis, blood transfusion, and hematology-oncology, covering the main areas of hematology practice.Guidelines are produced in 3 different formats.First, evidencebased guidance is produced using a standardized process of conducting systematic reviews, following a primary systematic review of the evidence.Second, evidencebased guidance referencing other previously published evidence-based guidelines (eg, international guidelines) are produced through systematic review.Third, guidance and recommendations are used in areas in which less robust evidence is available but for which a degree of consensus is likely to benefit patient care.BCSH guideline writing groups are composed of appropriate experts (consultants or senior healthcare scientists in practice in the United Kingdom), a member of the relevant task force, and representatives of relevant professional and patient bodies.The writing group members are approved by the task force.After formation of the writing group, databases are searched with appropriate keywords, search period, and inclusion and exclusion criteria.All references are sourced and evaluated by the group and recommendations are formulated.An audit tool is attached to each guideline to assess adherence to the guidance.The GRADE nomenclature is currently in use for evaluating evidence and assessing the strength of recommendations. 1 When complete, guidelines are reviewed by both the relevant task force and then by "sounding boards," which are composed of practicing hematologists and provide peer review.When the final guideline is agreed, it is posted on the Web site.