Kirsten Bibbins-Domingo, PhD, MD, MAS; Evelyn Whitlock, MD, MPH; Tracy Wolff, MD, MPH; Quyen Ngo-Metzger, MD, MPH; William R. Phillips, MD, MPH; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Jennifer S. Lin, MD, MCR; Carol M. Mangione, MD, MSPH; Ann E. Kurth, PhD, CNM, MSN, MPH; Francisco A.R. García, MD, MPH; Susan J. Curry, PhD; David C. Grossman, MD, MPH; C. Seth Landefeld, MD; John W. Epling, Jr., MD, MSEd; Albert L. Siu, MD, MSPH
Disclosures: Dr. Bibbins-Domingo is the current chair of the U.S. Preventive Services Task Force (USPSTF) and has been a member since 2010. Dr. Whitlock reports a contract for support work from Kaiser Permanente during the conduct of the study. Dr. Lin reports funding from the Agency for Healthcare Research and Quality to support the USPSTF during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2656.
Requests for Single Reprints: Lisa Nicolella, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Bibbins-Domingo: Department of Medicine, University of California, San Francisco, 550 16th Street, Box 1364, San Francisco, CA 94158.
Dr. Whitlock: Patient-Centered Outcomes Research Institute, 1828 L Street, NW, Suite 900, Washington, DC 20036.
Drs. Wolff and Ngo-Metzger: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857.
Dr. Phillips: Department of Family Medicine, University of Washington, Box 356390, Seattle, WA 98195.
Dr. Davidson: Columbia University Medical Center, 622 West 168th Street, New York, NY 10032.
Dr. Krist: Virginia Commonwealth University, One Capital Square, 830 East Main Street, Room 631, Richmond, VA 23219.
Dr. Lin: Kaiser Permanente Research Affiliates Evidence-based Practice Center, 3800 North Interstate Avenue, Portland, OR 97227.
Dr. Mangione: University of California, Los Angeles, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90024.
Dr. Kurth: Yale University, 400 West Campus Drive, Orange, CT 06477.
Dr. García: Pima County Health Department, 3950 South Country Club Road, Suite 100, Tucson, AZ 85714.
Dr. Curry: University of Iowa, College of Public Health Building, Room S153A, 145 North Riverside Drive, Iowa City, IA 52242.
Dr. Grossman: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.
Dr. Landefeld: University of Alabama at Birmingham, Boshell Diabetes Building, Room 420, 1808 Seventh Avenue South, Birmingham, AL 35233.
Dr. Epling: State University of New York Upstate Medical University, Madison–Irving Medical Center, Suite 200, 475 Irving Avenue, Syracuse, NY 13210.
Dr. Siu: Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1070, New York, NY 10029.
Author Contributions: Conception and design: K. Bibbins-Domingo, T. Wolff, Q. Ngo-Metzger, W.R. Phillips, K.W Davidson, A.H. Krist, F.A.R. García, S.J. Curry, D.C. Grossman, J.W. Epling, A.L. Siu.
Analysis and interpretation of the data: K. Bibbins-Domingo, E. Whitlock, Q. Ngo-Metzger, W.R. Phillips, A.H. Krist, C.M. Mangixpp one, A.L. Siu.
Drafting of the article: K. Bibbins-Domingo, Q. Ngo-Metzger, W.R. Phillips, A.H. Krist, F.A.R. García, S.J. Curry, A.L. Siu.
Critical revision of the article for important intellectual content: K. Bibbins-Domingo, E. Whitlock, T. Wolff, Q. Ngo-Metzger, W.R. Phillips, K.W Davidson, A.H. Krist, J.S. Lin, C.M. Mangione, A.E. Kurth, F.A.R. García, S.J. Curry, D.C. Grossman, C.S. Landefeld, J.W. Epling.
Final approval of the article: K. Bibbins-Domingo, E. Whitlock, T. Wolff, Q. Ngo-Metzger, W.R. Phillips, K.W Davidson, A.H. Krist, J.S. Lin, A.E. Kurth, F.A.R. García, S.J. Curry, D.C. Grossman, C.S. Landefeld, A.L. Siu.
Obtaining of funding: E. Whitlock, Q. Ngo-Metzger.
Administrative, technical, or logistic support: E. Whitlock, T. Wolff, Q. Ngo-Metzger, W.R. Phillips, K.W Davidson, A.H. Krist, A.E. Kurth, F.A.R. García, D.C. Grossman.
Collection and assembly of data: Q. Ngo-Metzger, W.R. Phillips.
The U.S. Preventive Services Task Force (USPSTF) summarizes the principles and considerations that guide development of its recommendations for diverse U.S. populations. It uses these principles through each step in the evidence-based guideline process: developing the research plan, conducting the evidence review, developing the recommendation, and communicating to guideline users. Three recent recommendations provide examples of how the USPSTF has used these principles: the 2015 recommendation on screening for abnormal blood glucose and type 2 diabetes; the 2016 recommendation on screening for breast cancer; and the recommendation on screening for prostate cancer, which is currently in progress. A more comprehensive list of recommendations that includes considerations for specific populations is also provided.
Table. Selected Examples of USPSTF Recommendation Statements That Incorporate Evidence on Specific Populations
Persons who have a family history of diabetes, have a history of gestational diabetes or polycystic ovarian syndrome, or are members of certain racial/ethnic groups (that is, African Americans, American Indians or Alaskan Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders) may be at increased risk for diabetes at a younger age or lower body mass index. Clinicians should consider screening earlier in persons with 1 or more of these characteristics.
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Barbara J Turner MD, MSED, MA, MACP, Thomas W. Concannon, PhD
Director, Center for Research to Advance Community Health at UT Health San Antonio, Senior Policy Researcher at The RAND Corporation
March 16, 2017
Greater Community Engagement in Developing Guidelines
TO THE EDITOR: In their article about methods used by the U.S. Preventive Services Task Force (USPSTF) to develop guidelines reflecting evidence relevant to specific populations, Bibbins-Domingo and colleagues briefly note that the USPSTF seeks public comments about draft research plans to develop guidelines and works with “partners” to implement and disseminate guidelines (1). Given the importance of understanding the needs and preferences of specific populations, we find that too little attention was devoted to describing how the USPSTF collaborates with consumers and other stakeholders while conducting systematic reviews and in the guideline development process. In contrast, the National Clinical Guideline Centre (NICE) offers detailed descriptions about how they involve patients, caregivers, and other stakeholders in multiple steps of guideline development including: suggesting topics, holding a stakeholder scoping workshop, and seeking comments during guideline development, after completion, and in the ‘validation period’ (2). In Australia, consumers also participate in all phases of guideline development, especially in defining special contexts to modify guidelines (3). Failure to involve consumers and stakeholders as legitimate partners throughout guideline development may have contributed to the turmoil following the 2009 USPSTF breast cancer screening guidelines (4). A web-based survey of over 1200 women aged 40-75 found that confusion increased for 30% of respondents after this guideline was published (5). Although it might not have been possible to avert the contentious response to this guideline, a more comprehensive process of listening to and partnering with consumers at multiple points in guideline development would demonstrate the USPSTF’s attentiveness to the views of the public. Especially when the USPSTF is striving to ensure that guidelines are appropriate for specific subpopulations, these experts should involve stakeholders from these groups throughout the process. Therefore, as researchers focusing on community-partnered research, we suggest that the USPSTF consider revising their methods to ensure that community stakeholders are well-integrated into the full spectrum of their activities. 1. Bibbins-Domingo K, Whitlock E, Wolff T, Ngo-Metzger Q, Phillips WR, Davidson KW, et al. Developing recommendations for evidence-based clinical preventive services for diverse populations: methods of the U.S. Preventive Services Task Force. Ann Intern Med. 2017 Mar 7. [Epub ahead of print]2. Hill J, Bullock I, Alderson P. A summary of the methods that the National Clinical Guideline Centre uses to produce clinical guidelines for the National Institute for Health and Clinical Excellence. Ann Intern Med. 2011;154(11):752-7. 3. Lukersmith S, Hopman K, Vine K, Krahe L, McColl A. A new framing approach in guideline development to manage different sources of knowledge. J Eval Clin Pract. 2017;23(1):66-72. 4. Morain SR, Concannon TW, Wittenberg E. HIV, breast cancer and vaccines: what do high-profile cases reveal about stakeholder engagement in research? J Comp Eff Res. 2017;6(1):43-49. 5. Squiers LB, Holden DJ, Dolina SE, Kim AE, Bann CM, Renaud JM. The public's response to the U.S. Preventive Services Task Force's 2009 recommendations on mammography screening. Am J Prev Med. 2011;40(5):497-504.
Bibbins-Domingo K, Whitlock E, Wolff T, Ngo-Metzger Q, Phillips WR, Davidson KW, et al. Developing Recommendations for Evidence-Based Clinical Preventive Services for Diverse Populations: Methods of the U.S. Preventive Services Task Force. Ann Intern Med. 2017;166:565-571. doi: 10.7326/M16-2656
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Published: Ann Intern Med. 2017;166(8):565-571.
Published at www.annals.org on 7 March 2017
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