VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain
Appendix E: Evidence Review Methodology
A. Developing the Scope and Key Questions
The CPG Champions, along with the Work Group, were tasked with identifying KQs to guide the systematic
review of the literature on LOT. These questions, which were developed in consultation with the Lewin
Team, addressed clinical topics of the highest priority for the VA and DoD populations. The KQs follow the
population, intervention, comparison, outcome, timing, and setting (PICOTS) framework for evidence
questions, as established by the Agency for Healthcare Research and Quality (AHRQ). Table E‐1 provides a
brief overview of the PICOTS typology.
Table E-1. PICOTS [254]
P
I
C
O
(T)
(S)
Patients,
Population, or
Problem
Intervention or
Exposure
Comparison
Outcome
Timing, if
applicable
Setting, if
applicable
A description of the patients of interest. It includes the condition(s), populations or subpopulations,
disease severity or stage, co-occurring conditions, and other patient
characteristics or demographics.
Refers to the specific treatments or approaches used with the patient or population. It
includes doses, frequency, methods of administering treatments, etc.
Describes the interventions or care that is being compared with the intervention(s) of
interest described above. It includes alternatives such as placebo, drugs, surgery, lifestyle
changes, standard of care, etc.
Describes the specific results of interest. Outcomes can include short, intermediate, and
long-term outcomes, or specific results such as quality of life, complications, mortality,
morbidity, etc.
Describes the duration of time that is of interest for the particular patient intervention and
outcome, benefit, or harm to occur (or not occur).
Describes the setting or context of interest. Setting can be a location (such as primary,
specialty, or inpatient care).
The Champions, Work Group, and evidence review team carried out several iterations of this process,
each time narrowing the scope of the CPG and the literature review by prioritizing the topics of interest.
Due to resource constraints, all developed KQs were not able to be included in the systematic review.
Thus, the Champions and Work Group determined which questions were of highest priority, and those
were included in the review. Table E-4 contains the final set of KQs used to guide the systematic review
for this CPG.
a. Population(s)
Adults 18 years or older with chronic cancer or non-cancer pain treated in any clinical setting were covered
in this systematic review.
b. Intervention(s)
Table E-2 lists the interventions that were covered in this systematic review. The interventions are listed
according to the KQs they address.
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