Aim To describe the use of qualitative research as evidence in a national clinical guideline program (National Institute for Health and Clinical Excellence – NICE, UK) and to identify training needs for guideline developers.
Methods All published NICE clinical guidelines from December 2002 to June 2007 were reviewed to determine whether qualitative studies were considered as evidence in the development of recommendations and how this type of evidence had been used. Developers of clinical guidelines due to be published between July 2007 and March 2008 were asked to describe their training needs regarding the use of qualitative research in clinical guidelines. Data were summarised using simple descriptive statistics.
Results Of the 49 clinical guidelines published by NICE within the study period, nearly half (45%, 22/49) used qualitative studies as an evidence base for developing recommendations for clinical practice. The number of qualitative studies used in these clinical guidelines increased from 2003 to 2006: 9 studies in 2003; 41 studies in 2004; 60 studies in 2005; 139 studies in 2006. In terms of how qualitative evidence was used in the guidelines, the study identified the following main issues: inconsistencies in the terminology used to describe types of qualitative study design; lack of standardised search strategies and/or targeted processes to select studies from databases; lack of a standardised approach to quality appraisal and poor reporting of how the identified evidence was used to inform the relevant guideline recommendations. Of the 17 clinical guidelines in development during the study period, the questionnaire was returned by approximately half of the guideline developers (response rate 47%, 8/17). A wide range of training needs was identified, chiefly training in the identification, quality appraisal and synthesis of qualitative studies and guidance as to the guideline areas where qualitative studies should be considered as evidence.
Conclusion Qualitative research is increasingly being used by NICE's clinical guideline developers as an evidence base to generate clinical practice recommendations. There are, however, clear training needs for NICE's guideline developers in terms of how best to identify, quality appraise and synthesise qualitative evidence for use in evidence-based clinical guidelines.