Guidelines
Other guidelines in preparation
Guidelines for the diagnosis and management of multiple myeloma 2011
Click here to download these guidelines.
Guidelines for supportive care in multiple myeloma 2011
Click here to download these guidelines.
UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): guidelines for the investigation of newly detected M-proteins and the management of monoclonal gammopathy of undetermined significance (MGUS)
Click here to download these guidelines.
Guidelines on the diagnosis and management of solitary plasmacytoma of bone, extramedullary plasmacytoma and multiple solitary plasmacytomas: 2009 update BCSH/UKMF
Click here to download these guidelines.
Guidelines for the use of imaging in the management of myeloma BCSH/UKMF
Click here to download these guidelines.
UKMF Guidelines Group Annual Report 2011
Jenny Bird
Consultant Haematologist, Bristol
Guy Pratt
Consultant Haematologist, Birmingham
Chair, Guidelines Committee, UK Myeloma Forum
Member BCSH Haematology-Oncology task force
(JB 2005-2011, GP 2011-)
Introduction
What is a clinical guideline?
Clinical guidelines are documents with the broad aim of guiding decision-making in
diagnosis, management, and treatment in specific areas of healthcare. They are based on an examination of current evidence within the paradigm of evidence-based medicine. The use of guidelines by healthcare providers can be an effective way of achieving several objectives such as reducing variation in practice and improving the overall quality of care. They usually contain a summary and evaluation of the best evidence and most current data on prevention, diagnosis, prognosis, therapy and in some cases cost-effectiveness. They aim to define the most important questions related to clinical practice and to identify key decision points. This may result in either summarised consensus statements or recommendations and/or development of treatment algorithms.
The guideline-based approach originated in the United States in the 1990s. They are usually produced at national/international levels by medical associations or government bodies and are frequently adapted for local use by local healthcare providers.
What are they for and who uses them?
They are mainly written to aid health care professionals in caring for patients with myeloma and fulfill a number of roles
- Educational resource
- Standardisation and improvement in quality of care eg. attempt to reduce postcode prescribing
- To aid development of local guidelines which in turn can inform negotiation with local fund-holders to access drugs
- Support service development eg. myeloma clinics
- Provide parameters to audit against
Guidelines can also be directly and indirectly informative to patients, particularly in the areas of what is the role of guidelines for patients?
- Education and assistance in decision- making and reassurance that treatment decisions/choices are appropriate
- Use in directing patient information supplied by Myeloma UK. They are also used as a resource for myeloma info-line and for development of material used in the MAGIC Nursing Education Programme
- Power to lobby health care providers for access to expensive and unfunded drugs
What are the difficulties associated with guideline writing?
- Assessing and grading levels of evidence
- Keeping guidelines relevant and updated
- Whether to update or re-write
- Where to publish - Internet or relevant medical journal
- How far to take into account the issues of access, NICE judgements, cost-effectiveness, licensed indications
- Lack of data in many areas eg. sequencing of therapies
- The issue of assessing cost-effectiveness
- Inadequate resources to undertake detailed analysis
- Duplication and lack of consistency between our guidelines and others
Why are our guidelines unique?
We believe that the UKMF/BCSH myeloma and related guidelines are unique because of the close collaboration of the group with Myeloma UK who provide financial support for their development and practical input to guideline development – keeping them ‘patient-focussed’
Are they useful?
We hope that they are and believe them to be so but would welcome views from any individuals about how they could be further improved. We know that they are regularly used by Myeloma UK for education/ lobbying purposes but also have some more objective evidence that they are being ‘used’. In 2006 the UK-Nordic myeloma guidelines topped the chart of most downloaded guideline from the BCSH website. In addition the hit rate to the BCSH website has increased from an average of 6,500 visits/month in 2003 to ~17,500 visits/ month in 2007 and continues to increase. Increasingly acknowledged and used by commissioners/NICE and other organisations involved in allocation of health care resources.
UKMF guidelines group 2000 to present – what have we done?
Guidelines published to date
- Guidelines on diagnosis and management of multiple myeloma 2001
- Updated recommendations for the use of bisphosphonates in myeloma 2003
- Guidelines on diagnosis and management of AL amyloidosis 2004
- Guidelines on diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma 2004
- Updated guidelines: UK Myeloma Forum and the Nordic Myeloma Study Group: Guidelines on diagnosis and management of multiple myeloma 2005
- Guidelines for the use of imaging in the management of myeloma 2006
- UKMF/NMSG Guidelines for the investigation of newly detected M-proteins and the management of MGUS. 2009
- Updated guidelines: The diagnosis and management of multiple myeloma 2011
- Supportive care in multiple myeloma 2011
Other publications
- Thalidomide in multiple myeloma: Current status and future prospects
- Position Statement on the use of Bortezomib in Multiple Myeloma
Guidelines group progress 2011
The UKMF Guidelines Group has recently published two guidelines on The diagnosis and management of multiple myeloma 2011 and Supportive care in multiple myeloma 2011 in the British Journal of Haematology and these guidelines are also available on the British Committee for Standards in Haematology website. These two guidelines represent a revision of the single 2005 Guidelines. The decision was made to split the revised guidelines into 2 independent documents. The main reason for this change is the rather unwieldy nature and length of the combined document and also recognition that, in light of the many advances there have been in the area of therapy, the treatment section may need more frequent updating than the supportive care document.
A revision of the ‘Guidelines on the diagnosis and management of AL amyloidosis is also underway with the aim of publication in 2012.
The future
Plans for future work of the Guidelines group include:
- Development of interaction with NICE particularly in view of possible future NICE guidelines for the management of myeloma
- Development of web-based guideline updates – focused on specific areas in which there have been recent developments. This will need to be done in conjunction with BCSH.
- Development of audit tools. Audit areas could include auditing uptake of guidelines by Cancer Networks and awareness of guidelines amongst UK haematologists
- Develop outcome measurement to assess value of guidelines e.g.monitor hits to BCSH website, keep records of presentations, Citation frequency, Informal comments
- Develop guidelines for primary care
- Executive summary –possible hard copy for distribution (separate grant would be needed to fund this)
- Encourage patient representation in guideline development
Guy Pratt
Jenny Bird
September 2011
UKMF guidelines group/Terms of reference
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