Conflict of interest disclosures for clinical practice guidelines in the national guideline clearinghouse.

Conflict of interest (COI) is an important potential source of bias in the development of clinical practice guidelines (CPGs) and high rates of COI among guideline authors have been reported in the past. Our objective was to report current rates of disclosure and specific author COI across a broad range of CPGs and to examine whether CPG characteristics were associated with the presence of disclosures and of conflicts.We selected a random sample of 250 CPGs listed in the National Guideline Clearinghouse on November 22, 2010, representing approximately a 10% sample of guidelines listed in the NGC on that date. We abstracted information on author COI from each CPG and examined predictors of the disclosures and COI using a logistic generalized estimating equation regression model. 87% of organizations developing guidelines had a CPG-specific policy, however, 40% of CPGs did not indicate that they had collected disclosures from guideline authors. In addition, 42% of organizations that did collect author disclosures did not have those disclosures available in the public domain. Of CPGs where we had disclosures for all authors, 60% had one or more authors with a conflict. On average, 28% of the authors of CPGs with available disclosures had a COI. Guidelines that were published in journals with an impact factor greater than 5.0 were more likely to have one or more authors with a COI than guidelines not published in journals.Rates of disclosure of author COI and the public availability of that information are unacceptably low, however rates of COI among guideline authors may have decreased in recent years. Continued efforts are needed to establish and enforce optimal COI policies in clinical practice guideline development in order to minimize the risk of bias associated with those conflicts

Association between clinical practice guideline characteristics and disclosures and conflicts (n = 250 guidelines).

<p>Abbreviations: CI, confidence interval; COI, conflict of interest; CPG, clinical practice guideline; IF, impact factor; NA, not applicable; OR, odds ratio.</p><p>(*) The presence of any disclosure in the clinical practice guideline (including disclosures of no COI, Yes versus No).</p><p>(**) Whether the presence of COI could be assessed for the CPG (Yes versus No, the latter including CPGs with no disclosures and CPGs with disclosures that were not publically available).</p><p>(***) P-value for the variable overall.</p

Characteristics of the included clinical practice guidelines (n = 250).

<p>n = 250 guidelines unless otherwise indicated.</p><p>(*) Includes one guideline from 2011 because at the time of abstraction, one guideline that was initially identified had been removed from the National Guideline Clearinghouse and thus the next guideline in our sequence of random numbers was selected, which was dated 2011.</p

Conflicts of interest among clinical practice guidelines and their authors.

<p>(*) % add to more than 100 because CPG authors can disclose more than one type of COI.</p><p>(**) Examples of activities for the types of COI: Advising/consulting: serving on an advisory board and/or executive committee, or receiving consulting fees, honoraria, speaking fees, or providing expert testimony; Research: receiving research grants, salary support; Patents/royalties: receiving income from patents or royalties; Stocks/equity: owning stock or equity in a company; Gifts: receiving gifts, travel, samples, or educational materials; Intellectual: publishing on a topic, providing unpaid advocacy; Other: time devoted to specific procedures, spousal employment.</p><p>Abbreviations: COI, conflict of interest; CPG, clinical practice guideline, SD; standard deviation.</p

Study flow diagram.

<p>Abbreviations: COI, conflict of interest; CPGs, clinical practice guidelines.</p