Health technology assessment (HTA) and the development of clinical practice guidelines (CPGs) support important health policy and clinical decisions. Conflicts of interest (COI) and conflicts of commitment (COC) can undermine the credibility and integrity of these processes, that of the actors involved, and, more alarmingly, the health of the population. Thus, management of COI and COC is critical. Although COI among experts participating in HTA and CPG development are increasingly discussed and managed, little is said about COCs and the possible COI and COC associated with patient participation. The aim of our study, which is part of the Institut national d'excellence en santé et services sociaux (INESSS) continuing improvement process for COI and COC management, was to identify best practices in this matter.

We examined the COI and COC management policies of ten HTA and CPG organizations and performed a review of the relevant academic literature.

Three HTA and CPG organizations had norms regarding the management of patients’ COI and COC, whether they were representatives of patient associations or not. These norms addressed situations such as: when a patient represents a patients’ association; when a patients’ association or an individual patient has important (financial) ties with the pharmaceutical industry; or when an expert or one of his/her family members suffers from the disease related to the HTA or CPG. The declaration of a COI or COC should not necessarily lead to the individual's exclusion from the entire HTA or CPG development process, but it must lead to some evaluation and management. Patients appointed to share their perspectives are not considered to have COI or COC if their mandate is explicit.

The COI and COC of all participants in HTA and CPG development should be managed fairly and transparently. Therefore, the management of COI and COC among patients participating in HTA or CPG development should be based on the same principles as those applied to clinical experts.