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CAP Guideline Principles

Evidence-Based Guidelines

The College of American Pathologists Pathology and Laboratory Quality Center (CAP Center) develops evidence-based guidelines by following the Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines to ensure a transparent and unbiased approach.

Establishing Transparency

The CAP Center produces guidelines alone or in conjunction with stakeholder partners. No industry funds are accepted for the development.

Management of Conflict of Interest

The CAP Center upholds guideline integrity by avoiding or actively managing conflict of interest, real or perceived, which could influence or be perceived as influencing guideline decisions. Panel members with potential conflicts of interest are often considered to be leaders within their field by industry, academic, and peer colleagues. The CAP strives to balance the panel between knowledgeable subject matter members and the desire to have a majority-free conflict-free panel. Conflict-of-interest disclosure is required throughout the guideline process, shared with all panel members, and cited in the manuscript.

Group Composition

The CAP Center composes panels are multidisciplinary, include a methodologist and represent major stakeholders, including patient advocates as appropriate.

Systematic Review

The CAP Center ensures the integrity via a systematic, unbiased review of the published medical evidence using guideline development best practices. The panel also considers professional input not documented in literature (eg, grey literature) based on its scientific merit and expert opinion.

Rating Strength of Recommendations

The CAP Center employs a modified grading system and the strength of evidence is reviewed in the considered judgment process which reviews the quality, quantity and consistency of the totality of the evidence; benefits/harms; values; costs (not necessarily cost-analysis or cost-effectiveness) and feedback from the open comment period and expert opinion.

Articulating Recommendations

CAP Center guidelines clearly articulate recommendations such that users may take appropriate action and implementation can be measured.

External Review

  • The CAP Center invites review and comment of its draft recommendations during an open comment period. The panel considers all comments during finalization of the recommendations.
  • The CAP Center uses an independent review process for guideline and guideline revision approval. The Independent Review Panel (IRP) consists of subject matter experts without conflict and not previously involved in guideline development including members of the CAP Council on Scientific Affairs.


CAP Center guidelines are reviewed every four years or earlier with the publication of substantive and high-quality medical evidence that could potentially alter the original guideline recommendations.