Guidelines: An Exploration and Discussion

The goal of this article was to explore the structure and evaluation of guidelines and to discuss those features applicable to the librarian serving clinicians, thereby meeting the suggestions for guidelines that the Institute of Medicine (IOM) initially suggested in 1990. A literature search of major biomedical databases was undertaken. In addition, organizations and textbooks were consulted. The search discovered components of guidelines in general, evaluation tools for those components, and a few evaluation tools for the guidelines themselves. A further exploration revealed attributes of guideline formation and development that serve to clarify both their value and limitations. It was determined that GRADE (Grading of Recommendations Assessment, Development, and Evaluation) most nearly meets the IOM’s recommendations. Its widespread acceptance, incorporation of patient values and/or preferences, and its inclusion of studies other than randomized controlled trials make it uniquely suitable to clinical practice.