Dunja Dreesens

88 Text box 2: International and cultural differences in guideline production INTERNATIONAL AND CULTURAL DIFFERENCES IN GUIDELINE PRODUCTION Guideline development methods have been developed by international networks and presented as universally applicable. But there may be differences in what methods are most appropriate for different contexts. In the workshops and conference sessions organised by the AID Knowledge Working Group, guideline developers from Europe, Latin America and Australia have generally welcomed efforts to include a wider range of types of knowledge in guidelines. USA- based guideline developers have been more critical, especially voicing the idea that any guidance not based on the highest level of evidence derived from RCTs should not be called a guideline. Such different assessments of what knowledge can/should be included in guidelines may have to do with the context in which guidelines are developed, including factors such as how the healthcare system is organised, who develops a guideline, litigation, what additional risks for conflict of interest this implies, and therefore whether guideline methods are more rigid. Approaches towards guideline appraisal and inclusion need to suit the context in which they are used. In this paper, we discuss four specific aspects of guideline development to highlight the main challenges identified by the GIN AID Knowledge Working Group through discussions and workshops with guideline developers and users (see Text box 3): - The purpose of guideline development; - The problem of induction; - The dominance of frequency based reasoning; - The challenge of integrating different sources of knowledge. In order to do this, we refer to some philosophical concepts around knowledge creation. Text box 3: About GIN AID and the development of this paper ABOUT GIN AID AND THE DEVELOPMENT OF THIS PAPER GIN AID is a working group of the Guidelines International Network (GIN). The AID Knowledge Working Group tries to contribute to bridging the gap in methods for Appraising and Including Different (AID) Knowledge. To support this ongoing challenge, the GIN AID Knowledge Working Group aims to: - Identify methods and promising initiatives for appraising and including a range of knowledge sources in guidelines; - Facilitate sharing experiences with suchmethods and their application in practice through workshops at GIN conferences and elsewhere; - Identify areas / questions for methodological development; Chapter 5