Managing Conflicts of Interest in the UK National Institute for Health and Care Excellence (NICE) Clinical Guidelines Programme: Qualitative Study

There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. Th...

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Bibliographic Details
Published in:PloS one Vol. 10; no. 3; p. e0122313
Main Authors: Graham, Tanya, Alderson, Phil, Stokes, Tim
Format: Journal Article
Language:English
Published: United States Public Library of Science 26.03.2015
Public Library of Science (PLoS)
Subjects:
Bias
Clinical medicine
Clinical practice guidelines
Conflict of Interest - legislation & jurisprudence
Conflicts of interest
Disclosure
Financial disclosure
Government Agencies - organization & administration
Guidelines as Topic
Humans
Interviews
Medical research
Policies
Policy
Qualitative Research
Researchers
Studies
Systematic review
United Kingdom
United Kingdom > UK
United States > US
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.
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Competing Interests: The authors have read the journal's policy and have the following competing interests: PA and TG declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. TS declares that the University of Birmingham, his employer, has received one honorarium from the pharmaceutical industry from lecturing on aspects of NICE’s work programmes. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
Conceived and designed the experiments: TS PA TG. Performed the experiments: TG. Analyzed the data: TG TS PA. Contributed reagents/materials/analysis tools: TG TS PA. Wrote the paper: TS TG PA.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0122313