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Everything You Need to Know About ASH Guidelines and Guideline Implementation: A Q&A With ASH Guideline Experts

December 11, 2022

EMILY BRYER, DO- Chief Fellow, Hematology & Oncology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD

DAVID H. HENRY, MD- Clinical Professor of Medicine, Vice Chairman, Department of Medicine, Pennsylvania Hospital, Philadelphia, PA

RACHEL P. ROSOVSKY, MD, MPH- Associate Professor of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

 

What should ASH News Daily readers know about accessing and using ASH clinical practice guidelines?

ASH guidelines provide easily accessible, evidence-based recommendations to optimize hematology care on an international scale. These clinical practice guidelines incorporate prevention, diagnostics, and therapeutics, and cover both classical and malignant hematologic conditions.

Currently, there are ASH guidelines available for venous thromboembolism, sickle cell disease, immune thrombocytopenia, acute myeloid leukemia, and von Willebrand disease. The ASH guidelines are a valuable and accessible tool for hematologists-in-training as well as practicing hematologists, and are available as pocket guides, educational teaching slide sets, videos, webinars, downloadable PDFs, and via the ASH Clinical Practice Guidelines App.

These guidelines are developed by a diverse group of multidisciplinary experts, including patients, who thoroughly and rigorously review the literature and subsequently create a high-quality, evidence-based document.

The ASH guidelines also offer transparency of the quality of evidence that guides the recommendation process by highlighting how final recommendations are agreed upon and including a statement about the level of certainty that supports every recommendation. Moreover, to ensure all voices are heard and appreciated, ASH opens guidelines in the development stage to physicians, patients, caregivers, and members of the public for public comment online. Lastly, ASH welcomes anyone to submit a topic for future guidelines.

 

In what ways do these guidelines make a concrete difference to clinicians/patients?

The increasingly rapid pace of hematology drug development has led to therapeutic advances that improve the way hematologists practice and improve patient outcomes. However, with these rapid advancements comes the challenge of staying up to date on current research. The ASH guidelines facilitate the provision of high-quality hematology care through easily accessible resources. ASH guidelines incorporate recommendations with justification, subgroup considerations, effect certainty, and easy-to-follow tables outlining the summary of findings.

Comprehension of both the scope and limitations of rapidly changing and growing information used to guide hematology practice provides context for conversations between clinicians and patients, and creates an opportunity for a personalized and evidence-based hematology treatment plan. Patients can take comfort in knowing that their care plan is rooted in evidence that is gathered by experts and incorporates continually updated clinical trial data.

 

How do we measure whether or not guidelines are being implemented?

ASH is committed to assessing guideline implementation and is offering a dedicated session at the 2022 ASH Annual Meeting titled ASH Guideline Implementation Champions [Sunday, December 11, from 9:30 a.m. to 11:00 a.m. in Room 353-355 at the Ernest N. Morial Convention Center], which highlights the implementation of three different guidelines. The presenters will walk through the impetus behind creating a program that addresses one of the guidelines, detail the challenges to implementing the program/guideline, and describe the ways they overcame those barriers as well as future directions.

Information regarding prior Guideline Implementation Champions is available on the ASH website (www.hematology.org/education/clinicians/guideline-sand-quality-care) in online seminar format and includes strategies to improve pain management in sickle cell disease, prevention of venous thromboembolism in ambulatory patients with cancer, and the standardization of diagnostic and therapeutic strategies for children with immune thrombocytopenia.

 

What are the most pressing unmet needs in hematology that may form the basis of future guidelines?

Across all medical specialties, including hematology, the paucity of diverse clinical trial participants limits the application of data generated through clinical trials and may affect patient outcomes. There is a persistent need to change the way we enroll patients in clinical trials with a goal of recruiting a population that more closely resembles the patients we treat.

In addition to diversity of clinical trial enrollment, other unmet needs in hematology include financial burden, which remains a significant barrier to patient access. Future guidelines may include potential financial resources such as pharmaceutical company patient assistance programs and foundations that may support or offset the cost of expensive therapies. Furthermore, ASH guidelines may present multiple pathways that incorporate financial implications and offer reasonable alternatives.

Finally, although there are multiple sets of ASH guidelines in both classical and malignant hematology, there are many more hematologic abnormalities commonly treated by providers who would benefit from the establishment of more sets of guidelines. Though guideline development requires rigorous methodology, intensive resource investment, and a strong evidence base, ASH is committed to addressing gaps in clinician guidance by developing new guidelines in the future.

 

How does one become a “Guideline Implementation Champion?” Can anyone do this?

Yes. Clinicians, researchers, or trainees who strive to implement any evidencebased guideline are eligible to become an ASH Guideline Implementation Champion. Applicants are not required to be trained in hematology but should propose a project that is grounded in at least one of the ASH clinical practice guideline recommendations.

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