Background: Bahrain Ministry of Health (MOH) published a 'Periodic screening for breast cancer in women' guideline 2010. Budgetary and time constraints necessitated outsourcing for creation of a comprehensive breast cancer management guideline. Strengthening of public and local non-governmental organisation (NGO) partnerships in health systems & service delivery has been emphasized in recent World Health Organization Reports
Objectives:To update and enhance the scope of the existing guidance, and ensure timely delivery of a high-quality (GRADE & AGREE compliant) breast cancer guideline for the MOH by engaging and sharing resources with local NGOs (Think Pink Bahrain, Bahrain Breast Cancer Society) and international publishers of evidence-based clinical references (EBSCO, Duodecim).
Methods: Guideline development, based on RAPADAPTE (accelerated ADAPTE), was sanctioned by the Bahrain Supreme Council of Health & National Health Regulatory Authority. A Guideline Development Group (GDG) was part funded by the NGO, and the Steering Committee and multidisciplinary expert panel members were sourced from the MOH. Foundational guidelines, previously identified as high-quality were selected and updated using current best-evidence clinical resources (DynaMed Plus, EBM Guidelines) and additional MEDLINE searches. AGREE II will be used to ensure the quality of the guideline.
Results:Recommendations from 2 foundational guidelines (Costa Rican, Catalan) were refined and expanded to 120+ clinical scenarios (PICO-specific recommendations) and evaluated for consistency with SIGN and NCCN guidelines. DynaMed Plus and EBM Guidelines were used for identification of new evidence. Guideline completion is projected for August following external peer review
Conclusions: Increased efficiency with reduced costs was achieved using a core team with methodological expertise in guideline development and previous experience with rapid adaptation. Freeing up the MOH clinical experts from the more intensive aspects of development whilst ensuring the core team was compensated for their contribution highlights a possible framework for a partnership of government with nonprofit NGOs.