Conflicts of interest disclosure forms and management in critical care clinical practice guidelines
Trustworthy clinical practice guidelines (CPGs) require identification and careful management of conflicts of interest (COIs) among all participants in the guideline development. Furthermore, COIs are more common than anticipated. However, there are no universally accepted methods to identify and manage COIs.
To describe and summarize the current COI disclosure forms and management policies in selected critical care professional societies that develop high-impact CPGs. In addition, we aim to provide suggestions to guideline developers on how to identify and manage different types of COIs.
We searched PubMed and MEDLINE for CPGs published between 2013 and 2018 in English language and addressed general critical care topics. We then ranked the CPGs according to the numbers of citations and selected the first five critical care professional societies that sponsored the guidelines. We obtained the most recent COI declaration forms and management policies. Two reviewers abstracted data on different types of COI in each of the disclosure forms and management policies.
All selected professional critical care societies require that members declare direct financial COIs; four societies inquire specifically about intellectual COIs (involvement in primary research). Three out of five societies require members to disclose indirect institutional financial COIs; however, none inquire about other forms of institutional COI. We developed, by consensus, a streamlined framework to classify and manage different types of COIs.
The current COI disclosure forms of selected professional societies provide more attention to financial disclosures and COIs and less attention to detecting and managing intellectual COIs, while rarely addressing institutional COIs. We provide some suggestions for guideline developers on the classification and management of different COIs in the context of CPGs.
KeywordsConflict of interest Critical care Clinical practice guidelines
Compliance with ethical standards
Conflict of interest
WA is the current Methodology Chair of the Surviving Sepsis Campaign guidelines and the lead methodologist on several clinical practice guidelines sponsored by SCCM, ESICM, and ATS, but did not receive any financial compensation for his role in these guidelines. WA is a member of the GRADE Working Group and the Chair of Guidelines in Intensive Care Development and Evaluation (GUIDE) Group, an academic group that provides methodology support to guideline developers in critical care. No financial COI to declare. RJ was a methodologist on several clinical practice guidelines produced by CHEST, ATS, SCCM, and ESICM. His role included dealing with COI issues and as such may constitute academic COI in relation to this manuscript. No financial COI to declare. BR has served as a methodologist on a number of guidelines for organizations such as SCCM, ESICM, ATS, ERS, and ASH. He has done consulting work in guideline methodology for Canadian Blood Services (a non-profit organization). MHM is the chair of the Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) and hereby involved in the development of clinical practice guidelines by the SSAI. MHM is part of the Guidelines in Intensive Care, Development and Evaluation (GUIDE) Group. No financial COI to declare. LE is the Chair of the Surviving Sepsis Campaign guidelines. No financial COI to declare. KCW receives a salary for his role as the ATS Chief of Documents and Patient Education. KCW has no other financial conflicts to declare. SP is the Manager, Guideline Methodology, for the American College of Chest Physicians (ACCP) and is an employee of the ACCPCMC, was the president of SCCM in 2015, and a panel member in the Surviving Sepsis Campaign guidelines. No financial COI to declare. MC is the Division Scientific Affairs Chair for ESIC. MGG is the Co-Chair of the GRADE working group. He served on the executive of a number of iterations of the ACCP anti-thrombotic guidelines, was Chair of the 9th iteration, and has published papers regarding how the 9th iteration dealt with COI. He has served in major roles (Chair, methodologist) on a number of other guidelines, including the Canadian Opioid guidelines, guidelines to address supportive measures for Ebola outbreaks, guidelines produced by the American College of Rheumatology, and AABB blood transfusion guidelines. GG has no financial conflicts to declare. EA served on the 9th and 10th iterations of the ACCP anti-thrombotic guidelines, was on the executive of the of the 9th iteration, and has published papers regarding how the 9th iteration dealt with COI. He has served in major roles (Chair, methodologist) on a number of guidelines, including guidelines produced by the American College of Rheumatology, the American Society of Hematology, and the World Health organization. He conducts methodological research in the area of COI. EA has no financial conflicts to declare.
- 3.Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E (eds) (2011) Clinical practice guidelines we can trust. National Academies Press, Washington (DC)Google Scholar
- 23.Guyatt GH, Akl EA, Crowther M, Schunemann HJ, Gutterman DD, Lewis SZ (2012) Introduction to the ninth edition: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):48S–52SCrossRefPubMedPubMedCentralGoogle Scholar
- 24.Agoritsas T, Neumann I, Mendoza C, Guyatt GH (2017) Guideline conflict of interest management and methodology heavily impacts on the strength of recommendations: comparison between two iterations of the American College of Chest Physicians antithrombotic guidelines. J Clin Epidemiol 81:141–143CrossRefPubMedGoogle Scholar