College of American Pathologists
CAP Guideline Principles

Improve diagnostic and treatment decision making

The CAP Pathology and Laboratory Quality Center (The Center) adopts the following guiding principles to ensure a transparent and unbiased approach to creating evidence-based guidelines.


  1. The CAP Center does not use industry funds for guideline development or
    revision. All Center guidelines are free from commercial bias and influence.
    Note: Company support of the overall CAP mission is not considered direct
    support of guideline development.

  2. The Center does not permit direct company support for printing, publication,
    and distribution of guidelines or guideline revisions.

Conflict of Interest Management and Workgroup Composition

  1. The 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.

    The Center considers the following categories when assessing possible
    conflicts of interest of potential work group members:
    • employment;
    • consultancy;
    • grant and research funding;
    • honoraria; patents and royalties;
    • board or advisory board membership;
    • expert testimony;
    • significant stock ownership;
    • ownership of items of substantial value;
    • vendor relationships;
    • family, professional, and business relationships and/or partnerships;
    • institutional financial interests;
    • leadership in associations; and
    • elected or appointed positions in other medical organizations.

  2. The Center will not appoint workgroup chairs, co-chairs, or members who have a direct and significant financial or otherwise significant relationship with a company whose product (eg, drugs or devices) might be affected by the guideline.

  3. Workgroup members with potential conflicts of interest are often considered to be leaders within their field by industry, academic, and peer colleagues. Guideline development often requires the inclusion of just this type of scientist or physician. The Center strives to balance the make-up of its workgroups between knowledgeable subject matter members and the desire to have a conflict-free panel.

  4. The Center requires conflict-of-interest disclosure throughout the guideline process. Conflicts are shared with members of the workgroup and cited in the guideline manuscript.

  5. The Center composes workgroups that are multidisciplinary, include a methodologist and represent major stakeholders, including patient representatives as appropriate.

Review of Evidence

  1. The Center ensures the integrity of Center documents via a systematic, unbiased review of the medical evidence using guideline development best practices.

  2. The workgroup gathers data from a wide variety of sources, including scholarly articles accepted for publication, published literature and/or individuals with subject matter expertise. While this approach ensures input from the most recent peer-reviewed trials or studies, the panel also considers professional input not documented in literature (eg, grey literature) - based on its scientific merit.

Recommendations and External Review

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

  2. The Center invites review and comment of its draft recommendations during an open comment period. Comments are kept confidential unless that protection is waived by the reviewer. The workgroup considers all comments during finalization of the recommendations.

  3. The Center uses an Independent Review Process for guideline and guideline revision approval. The Independent Review Panel process utilizes subject matter experts without conflict and not previously involved in guideline development. The CAP Transformation Program Office Steering Committee grants final approval of Center guidelines.