Changes

PHAC has taken steps towards addressing the issue of COI in guideline development by hosting a Best Brains Exchange on the topic<ref>Canadian Institutes of Health Research. Reducing and managing conflicts of interest in clinical practice guideline development: do we need Pan-Canadian standards? Government of Canada, 2019. Available from: http://www.cihr-irsc.gc.ca/e/51455.html</ref> in collaboration with CIHR. This meeting, which took place in January 2019, brought together over 60 participants representing academia, guideline producing groups from Canada and internationally, journal editors, and federal and provincial governments.  

PHAC has taken steps towards addressing the issue of COI in guideline development by hosting a Best Brains Exchange on the topic<ref>Canadian Institutes of Health Research. Reducing and managing conflicts of interest in clinical practice guideline development: do we need Pan-Canadian standards? Government of Canada, 2019. Available from: http://www.cihr-irsc.gc.ca/e/51455.html</ref> in collaboration with CIHR. This meeting, which took place in January 2019, brought together over 60 participants representing academia, guideline producing groups from Canada and internationally, journal editors, and federal and provincial governments.  

The principles put forward by the Guidelines International Network (GIN) are a key guiding document for improving the management of COI within guideline development, and were discussed extensively at the BBE.<ref>Canadian Institutes of Health Research. Reducing and managing conflicts of interest in clinical practice guideline development: do we need Pan-Canadian standards? Government of Canada, 2019. Available from: http://www.cihr-irsc.gc.ca/e/51455.html</ref><ref>Schünemann HJ, Al-Ansary LA, Forland F, et al. Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines. Ann Intern Med. 2015;163:548–553.</ref> The GIN principles provide a framework for consistent and appropriate management of COI in guideline development.<ref>Schünemann HJ, Al-Ansary LA, Forland F, et al. Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines. Ann Intern Med. 2015;163:548–553.</ref> While there was broad agreement that implementation of these principles would improve COI management in Canadian guidelines, it was felt by many that support would be needed to fully implement these principles across various groups.  

The principles put forward by the Guidelines International Network (GIN) are a key guiding document for improving the management of COI within guideline development, and were discussed extensively at the BBE.<ref>Canadian Institutes of Health Research. Reducing and managing conflicts of interest in clinical practice guideline development: do we need Pan-Canadian standards? Government of Canada, 2019. Available from: http://www.cihr-irsc.gc.ca/e/51455.html</ref><ref>Schünemann HJ, Al-Ansary LA, Forland F, et al. Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines. Ann Intern Med. 2015;163:548–553.</ref> The GIN principles provide a framework for consistent and appropriate management of COI in guideline development.<ref name=":0">Schünemann HJ, Al-Ansary LA, Forland F, et al. Guidelines International Network: Principles for Disclosure of Interests and Management of Conflicts in Guidelines. Ann Intern Med. 2015;163:548–553.</ref> While there was broad agreement that implementation of these principles would improve COI management in Canadian guidelines, it was felt by many that support would be needed to fully implement these principles across various groups.  

Overall, one clear theme emerged from the BBE: The need for national leadership, national standards, national approaches, and national transparency to help bring Canada up to the level of COI management seen in other countries. <ref>Canadian Institutes of Health Research. Reducing and managing conflicts of interest in clinical practice guideline development: do we need Pan-Canadian standards? Government of Canada, 2019. Available from: http://www.cihr-irsc.gc.ca/e/51455.html</ref>

Overall, one clear theme emerged from the BBE: The need for national leadership, national standards, national approaches, and national transparency to help bring Canada up to the level of COI management seen in other countries. <ref>Canadian Institutes of Health Research. Reducing and managing conflicts of interest in clinical practice guideline development: do we need Pan-Canadian standards? Government of Canada, 2019. Available from: http://www.cihr-irsc.gc.ca/e/51455.html</ref>

== PHAC COI assessment tool for guideline development ==

== PHAC COI assessment tool for guideline development ==

There is an important distinction to make between disclosed interests, and the presence of COI. Expert advisory panelists providing advice to PHAC or otherwise developing guidance (e.g., clinical practice guidelines) may have a wide variety of affiliations and interests. As noted by the World Health Organization, "''The declaration of one or more secondary interests (declaration of interests) does not automatically mean that a conflict of interest is present: there is a distinction between the two. A transparent and objective process for assessing a declaration of interests is required to determine if a conflict exists and what its effects might be, and to manage any significant conflict of interest."''<ref>World Health Organization. WHO handbook for guideline development (2nd Edition); Chapter 6 Declaration and management of interest. WHO 2014. Available from: <nowiki>https://apps.who.int/medicinedocs/en/m/abstract/Js22083en/</nowiki></ref> Figure 1 provides an overview of the link between disclosures of interests, and the identification and management of COI.

There is an important distinction to make between disclosed interests, and the presence of COI. Expert advisory panelists providing advice to PHAC or otherwise developing guidance (e.g., clinical practice guidelines) may have a wide variety of affiliations and interests. As noted by the World Health Organization, "''The declaration of one or more secondary interests (declaration of interests) does not automatically mean that a conflict of interest is present: there is a distinction between the two. A transparent and objective process for assessing a declaration of interests is required to determine if a conflict exists and what its effects might be, and to manage any significant conflict of interest."''<ref name=":1">World Health Organization. WHO handbook for guideline development (2nd Edition); Chapter 6 Declaration and management of interest. WHO 2014. Available from: <nowiki>https://apps.who.int/medicinedocs/en/m/abstract/Js22083en/</nowiki></ref> Figure 1 provides an overview of the link between disclosures of interests, and the identification and management of COI.

[[File:COI processes.jpg|center|frame|674x674px|<u>Figure 1.</u> An overview of processes involved in the disclosure and assessment of interests, and identification and management of COI]]

[[File:COI processes.jpg|center|frame|674x674px|<u>Figure 1.</u> An overview of processes involved in the disclosure and assessment of interests, and identification and management of COI]]

To facilitate such an assessment process for those involved in collecting and assessing disclosures of interests  

 

•The WHO¹, Haute Autorité de Santé (France)², GIN³, NITAG⁴, and NICE⁵ all outline factors to consider when assessing DOI for COI. These include:

Individuals involved with guidance development panels (within PHAC, Health Canada, or otherwise) are regularly collecting disclosures of interests from their panel members. Groups have expressed challenges in determining if COI is present and how to best manage COI. A variety of approaches are currently being used to determine COI and associated management options, and approaches are not always well documented, leading to concerns about consistency and transparency.

* Relevancy/specificity to the topic^1,2,3,5,

 

* Recency/currency ^1,2,4

* Frequency of the interest/relationship^2,4

* Aid the processes of COI management for groups that work with external bodies of experts

* Duration and depth of the relationship^1,4  

* Be used to consistently and transparently evaluate disclosed interests for the presence of COI, and determine the ideal management approach

* Amount (for financial interests)^1,4  

* The role of the individual in the guideline process/decision-making^1,2

* Relevancy/specificity to the topic<ref name=":0" /><ref name=":1" /><ref name=":2">Haute Autorité de Santé. Guide des déclarations d’intérêts et de gestion des conflits d’intérêts. HAS 2013 (revised 2017). Available: <nowiki>https://www.has-sante.fr/portail/upload/docs/application/pdf/guide_dpi.pdf</nowiki> (accessed May 15 2019).</ref><ref>National Institute for Health and Care Excellence. Policy on declaring and managing interest for NICE advisory committees. NICE, April 2018. Available: <nowiki>https://www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/declaration-of-interests-policy.pdf</nowiki>  (accessed April 4 2019).</ref>

* Recency/currency<ref name=":1" /><ref name=":2" /><ref name=":3">Agence de Médecine Préventive. Prevention of Conflicts of Interest in NITAGs: Principles and guidance to implement Conflict of Interest management policy. AMP 2017. Available: <nowiki>http://www.nitag-resource.org/media-center/document/3465</nowiki> (accessed May 15 2019). </ref>

* Frequency of the interest/relationship<ref name=":2" /><ref name=":3" />

* Duration and depth of the relationship<ref name=":1" /><ref name=":3" />  

* Amount (for financial interests)<ref name=":1" /><ref name=":3" />  

* The role of the individual in the guideline process/decision-making<ref name=":1" /><ref name=":2" />

Coming soon.

Coming soon.