ReviewReporting of declarations and conflicts of interest in WHO guidelines can be further improved
Section snippets
Background
Conflicts of interest (COI)—personal, organizational, and financial factors, which may affect the objectivity and independence of guideline contributors—are a potential source of bias in the development of clinical practice guidelines (CPGs) [1], [2]. COI occur when professional judgment concerning a primary interest (such as the validity of research) tends to be unduly influenced by a secondary interest (such as financial gain) [3]. Secondary interests can be classified as financial and
Eligibility criteria and study selection
We included all GRC-approved, WHO guidelines published in English from January 2007 to November 2016, including those developed in collaboration with other organizations. We obtained a list of all such guidelines from the GRC Secretariat and downloaded documents from the WHO website (http://www.who.int/publications/guidelines/en/). We included only the latest English-language version of each guideline. The full text of each guideline was independently screened by two researchers (X.Q.W. and
Results
We identified 208 guidelines approved by the GRC since its inception. Of these, 32 guidelines were excluded because they had been superseded by newer versions or were not published in English. Thus, 176 guidelines fulfilled eligibility criteria (Fig. 1).
The characteristics of included guidelines are shown in Table 1. The number of guidelines published annually ranged between 6 and 29. Of the guidelines, 143 (81%) were developed solely by WHO, including its regional offices; the remainder were
Discussion
The majority of WHO guidelines reported their funding sources; however, less than half presented the role of funders. Nearly 90% of the guidelines reported DOI, however of guidelines collecting DOI 38% did not provide details on how DOI were collected, and nearly half did not report how DOI were assessed. In addition, 21% of guidelines that reported one or more COI gave no information on how COI were managed. Seventeen percent of guidelines providing DOI did not report if COI existed. The most
Conclusion
The identification and management of COI, particularly nonfinancial interests, are challenging for all guideline developers; nonetheless, the collection and assessment of DOI and the management plan for any COI should be consistently reported in all guidelines. The majority of WHO guidelines performed relatively well with respect to reporting of funders and DOI and COI of external contributors in their guideline documents. This may be related to the quality assurance process at WHO implemented
Acknowledgments
The authors thank Rui L., Qingyuan Q., Hongxia Z., Shujun X., Yang Y., Baosen W., and Nan L. (Medical School, Lanzhou University, Lanzhou, China) for extracting data. The authors also thank Xiping S. (School of Public Health, Lanzhou University, Lanzhou, China) for helping with the statistical analysis.
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Conflict of interest: S.L.N. is an employee of the World Health Organization, where one of her responsibilities is to help oversee the quality of WHO guidelines, including the implementation of WHO's conflict of interest policy.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions: X.W., Y.C., and K.Y. contributed for conception and design. X.W., Y.C., Q.W., and S.L.N contributed for analysis and interpretation of the data. X.W., Q.Z., and L.Y. drafted of the article. X.W., J.E., and S.L.N critically revised the article for important intellectual content. X.W., Q.Z., L.Y., Q.W., J.E., Q.W., Y.C., K.Y., and S.L.N made the final approval of the article. J.E. contributed for statistical analysis. X.W., Q.W., Q.Z., and Q.W. contributed for collection and assembly of data.