The guideline developers were doctors David F. Ransohoff affiliated with North Carolina University, Epidemiology and Medicine Departments, and Lineberger Comprehensive Cancer Center. Harold C. Sox is affiliated with The Patient-Centered Outcomes Research Institute and the Geisel Medicine School (Ransohoff and Harold, 2016). The developers make recommendations to the United States Preventive Services Task Force (USPSTF) associated with colorectal cancer screening. Based on their affiliations, the guideline developers are critical stakeholders in the specialty. Before developing this guideline, Dr. Ransohoff was a two-validation CRC screening author using stool DNA (Ransohoff and Harold, 2016). Dr. Sox, on the other hand, was had chaired the USPSTF committee and was also a medical advisory member of the Epigenomics Corporation Board.
Based on the article information, both developers confirm their completion and submission of the ICMJE form for potential conflict of interest disclosure that any institution did not fund. Since 2002, Dr. Ransohoff reports he has never received any fees, associated income support, equity, or salary from Epigenomics, Exact Sciences, or any CRC-affiliated diagnostic product maker (Ransohoff, and Harold, 2016). However, he reported receiving investigator’s meetings travel reimbursement from Epigenomics and Exact Sciences. Dr. Sox, on the other hand, reported receiving no salary support, fees, disclosures, equity, or associated income for his service towards the development of the guideline (Ransohoff and Harold, 2016). The team had a solid strategy since they evaluated the 2008 and 2015 drat recommendation and shortlisted an acceptable screening strategies list via the efficient frontier (Ransohoff and Harold, 2016). They finalized their strategy by including an acceptable strategies list upon performing below the efficient frontier.
The team employed the near-efficient strategy to screen the shortlisted strategies and present its recommended statement. It was an explicit, sensible, and impartial process employed in selecting, identifying, and combining evidence. It can be argued the team conducted an extensive literature review 12 months before developing the guideline. The argument is founded on the procedure employed by the team in deciding the screening strategies. Having gone through the available guidelines and evaluating them, the team realized the inefficiency associated with the 2015 draft recommendation by USPSTF (Ransohoff and Harold, 2016). Using the 2008 screening guideline, the team works on the recommended screening strategies for colorectal cancer followed by evaluating the risks and benefits of the 2015 draft recommendation to the three provided tests. Their proposed guideline’s conclusion, therefore, became, “The USPSTF proposes colorectal cancer screening starting at 50 years and progressing to 75 years” (Ransohoff and Harold, 2016). Moreover, the conclusion also incorporates a segment where seven test strategies are included, with three associated with the 2015 draft recommendation, three considered alternative tests, and two being sigmoidoscopy and gFOBT tests without stool.
Every significant option and outcome were considered in the development of the guideline. The team factors the importance of the screening tests to both the patients and clinicians, the public and private sectors, and the significance of equal partner understanding of the potential outcomes and alternatives. The final recommendation later published by the authors constitutes a well-researched guideline backed with research findings from evaluating previous recommendations by USPSTF (Ransohoff and Harold, 2016). Through a microsimulation modeling study, the team presents a guideline tagged by scientific evidence. The proposed statement provides the pros and cons of the previous recommendations and provides alternative screening strategies.
Reflecting on the value judgment on the outcomes of the proposed statement, an explicit recommendation is made. Patients and clinicians are provided with an understanding of the value the screening tests have on colorectal cancer, helping them make informed decisions. However, the absence of a report representing task force recommendation on certain strategies or tests by the team results in ambiguity for the private insurer. However, no evidence shows the guideline has been subjected to peer testing and review.
The intent for the use of the guideline is national. The guideline works to improve the 2015 draft recommendation by USPSTF that has served the United States for more than 30 years. The previous guidelines have been associated with the transparent, scientific, and untainted analysis of the screening strategies and tests that have has encountered political influence and conflicts of interest. The recommendations made by the guideline can be argued to be clinically relevant. The team lists previous guidelines recommended screening strategies or tests, provides alternatives and includes two additional strategies (Ransohoff and Harold, 2016). That gives clinicians a more comprehensive range of tests to choose from when treating colorectal cancer.
The recommendation will play a significant role in helping me care for my patients. First, it provides the pros and cons of every screening test, meaning it helps patients make informed decisions on their preferred strategy. Despite the challenge with the private insurer on whether they must cover every specific test, the recommendation can be considered feasible (Ransohoff and Harold, 2016). The resources utilized to achieve the recommendations are practical since the proposed statement deals with patients ranging between 50 and 75 years (Ransohoff and Harold, 2016). Similarly, the tests are practical since they have been in existence for a long time. Following the procedure employed in developing the guideline, standard care can measure the outcomes. The recommendation is not a significant variation from current practice through the same process.
Ransohoff,, F. D., & Harold, C. S. (2016). Clinical practice guidelines for colorectal cancer screening: New recommendations and new challenges. JAMA, 315(23): 2529-2531.