Guidelines submitted to CMAJ

CMAJ publishes clinical practice guidelines and guidance for policy that are anticipated to have a substantial impact on health care in Canada and beyond.

Guidelines may be submitted as full guidelines or synopses if the guideline is more than 8-10 pages in length. Examples of recently published guidelines are available here.

Guidelines, including synopses, submitted for consideration must not be publicly available (e.g., posted online, prior publication), or under consideration by another journal.

We strongly suggest that guideline developers contact [email protected] well in advance of submission to discuss proposals.

ENDORSEMENTS

CMAJ considers guidelines developed or endorsed by relevant national or international specialty societies, colleges and associations.

PUBLICATION FEE

Payment of a publication fee is required for all guidelines published in CMAJ, which must be negotiated separately with the CMAJ Group Publisher in advance of submission. The Publisher will outline the suite of options (e.g., translation, print supplements) available. That an author group is able to pay the publication fee does not affect editorial decision-making.

GUIDELINE DEVELOPMENT

We expect that guidelines adhere to the AGREE II reporting guideline and that a recognized tool such as GRADE is used to grade the quality of evidence and strength of recommendations.

We strongly encourage that relevant stakeholders (e.g., patients, primary care physicians) are included in the guideline development group, not just content experts.

The GIN-McMaster Guideline Development Checklist is a useful resource that outlines practical steps for developing guidelines. A detailed description of how the checklist was developed is available in this CMAJ article.

COMPETING INTERESTS

All guidelines submitted must adhere to the Guideline International Network principles for managing competing interests in guidelines (full CMAJ policy).

GUIDELINE TEMPLATE

Guidelines published in CMAJ are typically 8-10 pages in length (as negotiated with the Publisher). If the guideline is longer, author groups should submit a guideline synopsis, with the full guideline included as an appendix.  

Guidelines submitted to CMAJ, whether synopses or full guidelines, are required to be in the template outlined below. Examples of recently published guidelines are available here.

WORD LENGTH

• 2750 words or less, excluding references, tables, figures and boxes.  

REFERENCES

• Fewer than 40 references to allow for maximum room for text.

ABSTRACT

• Consists of 4 parts (Background, Methods, Recommendations, Interpretation)

• Background (2 sentences: 1 for context and 1 for guideline objective. Include the name of the guideline developer organization in the objective sentence.)

• Methods (Brief description of development steps, including adherence to AGREE II, use of recognized guideline development process [e.g., ADAPTE] and grading scheme [e.g., GRADE], stakeholder engagement, adherence to Guideline International Network principles for managing competing interests)

• Recommendations (If the guideline has many recommendations, provide an overview focusing on the key recommendations; if a few recommendations, list these. Include important caveats.)

• Interpretation (1-2 sentences summarizing implications for practice or policy)

• 250 words or less

REQUIRED BOX

• Grading of Recommendations box (summary of GRADE or relevant grading rubric describing strength of recommendations and certainty of evidence, with relevant references. Number box and cite in first paragraph of Recommendations.)

REQUIRED TABLE

• Summarize all recommendation statements in a table, with each recommendation’s strength, and quality or certainty of the underpinning evidence.
• Cite in first paragraph of the Recommendations section.

INTRODUCTION (1^st section)

• Provide a brief overview of the guideline topic, including citing relevant epidemiologic data, along with why a new or updated guideline is required.

SCOPE (2^nd section)

• Describe the target patient population and to whom the guideline does not apply.  
• List end-users of the guideline (e.g., health care providers, policy makers and others).

RECOMMENDATIONS (3^rd section)

• Begin with a short paragraph that provides a brief overview of recommendations (e.g., number of recommendations, areas covered) and cites the “Grading of Recommendations” box and the “Summary of Recommendations” table.
• If there are no more than 6 recommendations, each recommendation should have its own subsection. Lead each subsection with the recommendation (in italics) followed by a description of the most pertinent research and the quality of the evidence supporting it, along with selected references.
• Describe the rationale for the recommendation (including factors such as balance of potential benefits and harms, cost-effectiveness and resource use, impact of patient values and preferences, feasibility, acceptability and equity).
• If there are more than 6 recommendations, select out the most important recommendations or major changes in recommendations to discuss.

METHODS (4^th section)

• At minimum, include the 6 subsections outlined below, after the first paragraph.
• First paragraph
  • State the overall approach used to developing recommendations (e.g., use of GRADE, ADAPTE).
  • Indicate that the guideline follows the AGREE II guidance.
  • Include the name of the guideline developer organization, along with the main guideline funder(s). A detailed funding statement should be included at the end of the submission.
• Subsection 1: Composition of participating groups
  • Which stakeholders were involved; the number of members in each group and their expertise; and the role of each group.
• Subsection 2: Selection of priority topics
  • How this was done and by whom, including how decisions were made.
  • The full analytic framework should be in an appendix.
• Subsection 3: Literature review and quality assessment
  • Describe the search strategy and data extraction; what grading scheme was used and how it was applied.
  • Include evidence tables in an appendix if they are not published elsewhere.
• Subsection 4: Development of recommendations
  • Describe the process from the draft to final version of the recommendations, including how decisions were made and by whom.
• Subsection 5: External review
  • Which external stakeholder, end-user and other groups reviewed the draft, when this was done, and whether any changes were made.
• Subsection 6: Management of competing interests
  • Cite the Guideline International Network principles
  • Describe clearly how and when competing interests were collected; how they were mitigated; and who provided oversight.
• Please include the time frame for any meetings or processes and how they were conducted (e.g., virtually, in-person, email). Add author initials for any activities in which not all authors were involved.

IMPLEMENTATION (5^th section)

• Describe implications for resource use, knowledge translation strategies and how implementation should be tracked and measured.
• Include when the guideline will be updated and by whom.

OTHER GUIDELINES (6^th section)

• Describe how the recommendations differ from those in previous guidelines, citing other relevant major national or international guidelines.
• A table is useful to summarize this information.

GAPS IN KNOWLEDGE (7^th section)

• Outline substantial gaps in the literature that could inform future research.

LIMITATIONS (8^th section)

• Present a summary of limitations of the guideline methodology and its execution.  

CONCLUSION (9^th section)

• In a brief paragraph, summarize the main guideline recommendations and their implications.

TABLES, BOXES AND FIGURES

• As noted earlier, there are 2 required boxes and 1 table.
• Article word count may need to be reduced depending on the size and number of any additional boxes, tables or figures.
• We suggest the use of colour in any included figures.

APPENDICES

• For synopses:
  • At submission, submit the full guideline as an appendix.
  • At publication, the full guideline is typically included as an online appendix but will not be edited by CMAJ.
  • However, guideline groups may prefer to host the full guideline elsewhere; in that case, a link will be included in the published version of the synopsis.
• CMAJ welcomes infographics, knowledge translation tools and other supplementary materials (such as evidence-to-decision tables) for appendices. These will not be edited by CMAJ, unless this is negotiated in advance with the Publisher.

OTHER

• Endorsements (include a list of endorsing organizations.)
• Competing interests (on submission, provide a summary of competing interests or completed International Committee of Medical Journal Editors (ICMJE) forms for each author).  Completed forms are required upon acceptance.
• Other components include: Author affiliations (up to 2 for each author), Contributor statements (all authors must fulfill ICMJE criteria for authorship), Funding statement and Acknowledgements.

SUBMISSION

• Submit your guideline here, after formatting it with the template above. Select: Review – clinical practice guideline as the article type.
• Please be reminded that all guidelines submitted to CMAJ must have a negotiated quote from the Publisher to be considered for publication. However, that a guideline group is able to pay this fee does not affect editorial decision-making.
• Guidelines undergo this editorial process.

PUBLICATION PLAN

• Upon acceptance of a guideline for publication, CMAJ will work with guideline groups to develop an individualized publication plan.
• The details of the plan will vary depending on the negotiated quote.

For more information on publishing guidelines in CMAJ, please contact us here.