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ACP details how it manages conflicts of interest for clinical guidelines

The ACP said it uses an intensive process to evaluate and manage conflicts of interest among those who participate in the development of clinical guidelines.

“In recent years, medical societies have received national attention and criticism for [conflicts of interest (COIs)], particularly with regard to clinical guidelines,” Amir Qaseem, MD, PhD, MHA, vice president of clinical policy and the Center for Evidence Reviews at the ACP, and Timothy J. Wilt, MD, MPH, professor of medicine at the Minneapolis VA Medical Center, wrote in a paper published in Annals of Internal Medicine. “The absence of trust may serve as a barrier to implementation and impede the ultimate goal of clinical guidelines, which is to improve patient care and outcomes.”

To ensure that their clinical guidelines are trusted, the ACP’s Clinical Guidelines Committee requires all those who may participate in the development of clinical guidelines — including committee members, public panel members, those involved in systematic reviews commissioned by the ACP, ACP staff, and guests attending committee meetings or conference calls — to disclose health care-related interests for the previous 3 years.

The disclosures include all current and former intellectual and financial health care-related interests such as employment information, research and consulting work, health care-related investments, work on boards, committees, and similar professional activities, in addition to any other aspect of a participant’s life that may be a relevant interest.

Once the disclosures are reported, the DOI-COI Review and Management Panel reviews them to determine how an individual can participate in the development of clinical guidelines. Reviewers divide COIs into three categories: high-level, moderate-level and low-level.

High-level COIs include active relationships with a group that would be affected financially by clinical guidelines, such as drug and medical device companies. After a COI is determined to be high-level, participants can either end their association with a company and be downgraded to a low-level COI or must stop all involvement in development of the guidelines

Moderate-level COIs are typically made of intellectual interests that are relevant to the topic of the clinical guidelines being developed. Those with moderate-level COIs have partially restricted participation in guideline development, as their experience with a topic may result in cognitive bias that could affect guideline development.

Low-level COIs include participants who previously had high-level COIs but the relationship or interest ended within the last 3 years and those with intellectual interests only slightly related to the topic of the guidelines. Participants with low-level COIs can participate fully in the development of clinical guidelines.

All disclosures and decisions regarding COI management made during the development of clinical guidelines are available to the public and free to access.

“ACP’s comprehensive process for disclosure of interests and management of conflicts of interest is designed to be transparent, proportionate, and consistent,” ACP President Robert M. McLean, MD, FACP, said in a press release. “The goals of our process are to mitigate any actual bias during the development of ACP’s clinical recommendations and to ensure credibility and public trust in our clinical policies by reducing the potential for perceived bias.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.