Clinical Practice Guidelines and Standards of Care

Key Points

  • Clinical practice guidelines are published by professional medical organizations to inform healthcare professionals and providers about benefits and risks of diagnostic and treatment options.
  • Using rigorous evidence-based methods, reviewers assess the strength of evidence for each recommendation.
  • The Society for Integrative Oncology creates authoritative clinical practice guidelines for integrative cancer care.
  • Standards of care relate to reasonable and customary established standards and are often considered in malpractice actions.

Clinical practice guidelines are statements developed by third-party organizations such as these:

  • Institute of Medicine
  • Centers for Disease Control and Prevention
  • Agency for Healthcare Research and Quality
  • National institutes such as the the National Comprehensive Cancer Network
  • US Preventive Services Task Force
  • Office of The Army Surgeon General
  • Professional medical societies such as the Society for Integrative Oncology
  • Professional medical journals
  • Academic medical institutions, such as the University of Texas School of Nursing

Guidelines are created, usually by a panel of experts looking at all the evidence for or against a therapy. A systematic review is conducted using rigorous evidence-based methodology. The strength of evidence for each recommendation explicitly stated. Reviewers conduct an assessment of the benefits and harms of therapies and treatments.

Guidelines serve several purposes, including these:

  • Assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances
  • Define for healthcare professionals the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. 

While guidelines identify and describe generally recommended courses of intervention, they are not presented as a substitute for the advice of a physician or other knowledgeable healthcare professional or provider.

SIO Recommendation Grades

The Society of Integrative Oncology grades therapies according to the evidence of benefit or harm, with a corresponding recommendation for or against use. This is a typical grading system, although the grade labels vary among publications:1

  • Grade A recommends the therapy (there is high certainty that the net benefit is substantial: offer/provide this therapy).
  • Grade B recommends the therapy (there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial: offer/provide this therapy).
  • Grade C recommends selectively offering or providing this therapy to individual patients based on professional judgment and patient preferences (there is at least moderate certainty that the net benefit is small: offer/provide this therapy for selected patients, depending on individual circumstances).
  • Grade D recommends against the therapy (there is moderate or high certainty that the therapy has no net benefit: discourage the use of this therapy).
  • Grade H recommends against the therapy (there is moderate or high certainty that the harms outweigh the benefits: discourage the use of this therapy).

These guidelines are not fixed protocols that must be followed, but they inform healthcare professionals and providers about benefits and risks of diagnostic and treatment options.

While guidelines identify and describe generally recommended courses of intervention, they are not presented as a substitute for the advice of a physician or other knowledgeable healthcare professional or provider.2

The Society for Integrative Oncology creates authoritative clinical practice guidelines for integrative cancer care: Integrative Oncology Guidelines.

Standards of Care

A standard of care is “a diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.”3 Standards of care are often called on in malpractice or other legal actions wishing to show that a healthcare provider failed to provide care or performed harmful actions outside reasonable and customary established standards. A 2011 article provided this legal interpretation: “the standard of care is what a minimally competent physician in the same field would do in the same situation, with the same resources.”4

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