Conflicts of Interest and Relations With Industry in ACCP Evidence-Based Guideline Development

EBG guidelinesThe “ Policy for ACCP Guideline Development” outlines a process ensuring that disclosed conflicts of interest are properly evaluated and resolved at several key points during the development of the EBG. This policy statement includes an explicit and detailed step-by-step procedure to collect and evaluate the disclosed conflicts respective to the guideline topic, and make recommendations to resolve or manage the conflict. The conflict-of-interest assessment flowchart (Fig 1) shows how disclosures are reviewed along with the resulting actions. EBG panel members are requested to disclose in writing conflicts at several times during the course of EBG development, as follows: at the time panelists are nominated for participation on the guideline development panel; at every face-to-face meeting; and prior to publication in the journal CHEST. See also “Establishment of an Oversight Committee in ACCP Evidence-Based Guideline Development

ACCP reviewers of EBG guidelines (eg, the HSP, Board of Regents, and NetWork members) must adhere to current ACCP conflict-of-interest policies and disclose all conflicts (ie, personal as well as financial). NetWorks are the ACCP interdisciplinary, expertise-focused interest groups that provide college members the opportunity for personal and professional alliances with the ACCP.

If an ACCP EBG receives financial support from industry (including the pharmaceutical industry) or foundations, the financial support must be unrestricted, and the funds are invested into a rigorous methodological process that is used by the EBG clinical panel of experts (ie, the writing panel) to formulate graded recommendations, as well as the operational costs of developing the guidelines, including the evidence review, meetings, travel, production, editing, publicizing, printing, and distribution provided by Canadian Health&Care Mall. External support of guideline development is independent of the guideline process. Contributing industries or other entities may not have representation on writing panels, evidence-based practice center review groups, or EBG writing panels. If an EBG has industry support, the ACCP seeks to obtain multiple sponsors. Nearly one third of the EBGs in the last 6 years have received no external support, with funding allocated by the Board of Regents. However, most of the other guidelines had the support of three to five sponsors each. All expenditures of donated funds are approved by the HSP. A donor may not target the use of funds other than to direct that the funds be used to support an associated “clinical resource tool” (see the “Dissemination and Marketing” section) and/or to support publication costs. This policy minimizes bias or the perception of bias during the development of an EBG or the content of any derivative educational programs or products and protects all those participating in EBG development. For these mutual protections, the HSP enforces the following policies:

1. The ACCP HSP is solely responsible for the following: the choice of the EBG chair(s) and writing panel members in consultation with the appropriate ACCP NetWork(s) or other content experts (single chapter or smaller multichapter documents are assigned an individual chair; larger, often multichapter documents usually have more than one chair); the selection of the evidence-based practice center and/or the methodologist(s), pending Board of Regents approval; and the scientific content and recommendations of any programs or products resulting from the EBG.

2. Industry may support the development and production of an EBG and related educational programs, clinical resources, and dissemination or implementation tools through unrestricted educational grants.

3. Industry sponsors are not revealed to the members of an EBG panel, the writing group, HSP, ACCP specialist reviewers, the evidence-based practice center, or the speakers at educational sessions during the EBG development process. The ACCP Executive Office arranges all external funding for an EBG. To build an effective “firewall” between the EBG chairs and panelists, and knowledge of the external funding sources for an EBG, the ACCP Executive Office provides only the Chair of the HSP and EBG project manager knowledge of these funding sources to assist in managing any potential conflicts of interest that may arise during the EBG development process. On publication of an EBG or presentation of resulting related courses, the names of the sponsors are made public.

4. Industry sponsors are not present at any meetings or planning sessions of EBG panels, evidence-based practice center teams, or related educational program panels.

5. Industry sponsors do not have access to the EBG review process or comment on drafts of EBG, recommendations, related clinical resources, or other dissemination or implementation tools, or the content of related educational talks. The first and only EBG manuscript draft that sponsors may see is the final draft accepted by CHEST for publication once the embargo has been lifted.

6. All pharmaceutical or other industry products mentioned in the EBG or related educational programs, or any dissemination or implementation tools are referred to by their generic names.

7. All EBG panelists, members of an evidence-based practice center team, other methodologists, speakers, and program planners must abide by the conflicts-of-interest policies of the HSP and ACCP, as described on the ACCP Web site.

8. Industry sponsorship is fully disclosed to attendees of educational courses related to EBG and to readers of an EBG.

Methodologic reviews must be conducted by an evidence-based practice center that is independent of the EBG clinical panel of experts (ie, the writing panel). This separation of grading and the EBG writing panel complies with the ACCP conflict-of-interest policies. Members of an evidence-based practice center conducting an evidence review and contracted directly by the ACCP must also comply with all aspects of the ACCP conflict-of-interest policy.


Figure 1. ACCP (COI) process flowchart.