Current trends in guideline development: a cause for concern.

Although the development and use of practice-related guidelines as educational aids has a long history in the health professions, scientific assessment indicates that they have had limited success in changing practice patterns. This is principally due to the exclusion of practitioners from the development process, and the lack of a credible scientific basis for many guidelines. Past failures have led to new methods of guideline development based on a critical analysis of scientific data. These methods, which involve legitimate professional organizations at all stages of the development process, are clearly a step in the right direction. Unfortunately, there are signs that current guideline developers still fail to recognize the critical nature of the new methods or the need for an open and inclusive development process. It is even more disquieting that the objective of some guideline developers, such as licensing bodies, is the formulation of standards or review criteria, particularly when there are very few therapeutic practices with a sufficient scientific basis to justify such a designation. National and provincial societies, as well as dental educators, need to assume a leadership role to ensure that if guidelines are required, they will be developed as credible aids for the improvement of patient care. In this paper, the authors recount why the "traditional process" of guideline development resulted in guidelines that were mistrusted by the profession and, as a result, ineffective. They also outline the widely-documented current methodology, which should be followed if guidelines are to be accepted by the profession. Finally, they discuss the critical issue of who should develop guidelines, and examine their role in dental practice and education.