FinOHTA, STAKES, Finland
What is a Guideline?
The purpose of a guideline is to assist practitioners and patients in making decisions about healthcare interventions in a specific situation (IOM 1990?)
Different types of guidelines
Guidelines are produced through different processes and their quality varies. Evidence based guidelines are based on a systematic analysis of existing literature and appraisal of the evidence. Guidelines can also be based on a consensus of clinical experts, stakeholders etc.
The level of evidence for each existing guideline depends on the quality and amount of existing studies and on uniformity of this evidence.
Guidelines need to be updated at regular intervals. New research may either strengthen or weaken the evidence.
What is guidance?
Guidance is information or counseling as to how or where a particular disease or situation can be handled. Guidance can been given orally, in written documents or through media (TV, web, videos). In clinical practice the purpose of guidance is to help people make their own decisions based on their values. Within health care the purpose of guidance is to instruct the health care providers for optimal use of resources.
Guidance is a spectrum
Guidance includes information on a range of topics. Guidance can e.g. give information to pregnant women on the content, meaning and consequences of participating in screening for fetal abnormalities. Guidance provides information on how to calculate your personal risk for a disease (e.g. heart diseases- blood pressure, age, cholesterol level etc.). Guidance can also include recommendations on reducing your risk (e.g. how to stop smoking, reduce drinking etc.).
The legal status of guidance varies from country to country and may also be dependent on the context of the issue in question. It may provide legally binding boundaries for those patient groups that are to receive a specified treatment (e.g. reimbursement of a drug for only specified types of patients with the same disease). It may also give various options as to how a specified issue should be handled within a health care system (e.g. alcohol abuse).
Guidance is a process
Guidance does not give straightforward answers to the patient but helps the person to understand the process or intervention. The person should be given as much guidance as she/he needs in order to make her/his own decision.
Guidance is changed with increasing knowledge, changes in existing resources etc.
What is advice?
Advice is a statement or opinion as to how one should proceed. The purpose of advice is to influence.
Advice can be based research evidence, professional experience, personal opinion/experiences or even societal norms.
As advice tries to influence it includes clear recommendations as to what to do, where to go, what to decide etc. The advisor has already made the value laden weighing of different options.
What is Protocol?
Protocol is a set of directions or rules regarding a sequence of activities in a specified situation or setting. The directions are formulated in advance and are recorded in some way. The purpose of a protocol is to give a general structure for the activities and by doing so to help collaboration between persons, organisations and societies.
Different types of protocol
Since a protocol has been devised for a special operational environment, it varies from one context to another. A protocol can direct a clinical procedure. Other examples are research protocols (including those for HTA) and specified rules regarding data transmission.
Updating of protocol
A protocol should be amended when it becomes necessary e.g. to improve functioning of an organisation.