From: GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context
Category of Challenge | Specific Challenge | Proposed Solution |
---|---|---|
Resources | • Suboptimal original data from Pakistana | • Make use of regional literature • Judicious use of grey-literature |
• Structuring the GRADE-ADOLOPMENT process to the resource-constrained context of Pakistan (revise through experience, highlight resource gap)b | • Conduct a thorough, realistic resource assessment, and highlight resource gaps • Revise process accordingly through experience | |
• Inadequate manpower/size of workforcea | • Involve students and trainees on a volunteer basis | |
Stakeholder Support & Involvement | • Suboptimal departmental supportb | • Involve all stakeholders from the start • Emphasize and reiterate mutual interests • Design specific curricula for all stakeholders involved • Tailor and deliver presentations to all stakeholders involved • Collaborate with patient advocacy groups • Community outreach and education • Involve Medical Societies for review of guidelines • Invite external topic specialists |
• Suboptimal provincial/federal government involvementa | ||
• Suboptimal involvement of external societies or organizationsa | ||
• Absence of patients’ perspectivea | ||
• Absence of general practitioners’ perspectivea | ||
• Absence of the allied health perspectivea | ||
Resistance to Change | • Experts’ doubts regarding need for local EBCPGsb | • Initial presentation to emphasize need for local EBCPGs, robustness of the GRADE-ADOLOPMENT process, and the importance of strict adherence to rigorous GRADE-ADOLOPMENT processes in order to produce credible guidelines |
• Experts’ exercising caution/opting for middle-ground with regards to decision-making in ETD tableb | • Emphasize the anonymity of the ETD process • Emphasize importance of incorporating varying schools of thought in the adaptation process | |
• Experts’ doubts regarding nationwide implementation of local guidelinesa | • Involve decision-makers from other institutions across the country and ensure buy-in to the newly adoloped EBCPGs | |
Methodological Limitations | • Individual-level biases from expertsb | • Increase the number and diversity of experts • Gauge acceptability and accuracy of any revisions made by getting feedback from experts from external institutes |
• Group-level biases from expertsb | ||
• Suboptimal generalizability of consensus opinion based on 5 expertsb | ||
• Expert opinion is no substitute for the lack of scientific evidencea | • Supplement the expert opinion with as much auxiliary evidence as possible • Plan future studies to answer specific questions that arise during the GRADE-ADOLOPMENT process |