As part of NSGC's mission, the Practice Guidelines Committee (PGC) is charged with developing trustworthy clinical practice guidelines to help promote the provision of high quality, evidence-based care. The PGC is committed to minimizing any real or perceived conflict of interest (COI) for anyone involved in the guideline development process. Presence of a COI does not automatically preclude participation in an NSGC Practice Guideline activity and the PGC recognizes that many experts may have a COI to disclose. In many cases, fully disclosing the actual potentially conflicting relationship will, by itself, suffice.

This survey broadly collects information pertaining to potential COI to help the PGC be as transparent and honest as possible. The PGC will evaluate disclosures as relevant to your specific role(s) and often will not preclude your involvement in a specific PGC initiative.

To the best of your knowledge, please answer each of the following questions and disclose any relationships that you currently have (or have had) during the preceding 12-month period (unless otherwise noted). We greatly appreciate complete answers to these questions, even if you do not think they directly relate to the specific PGC work for which you are being considered. Given the thoroughness of this form, many individuals will have a potential COI to disclose.

PGC members will keep all survey answers you provide strictly confidential. However, if you are uncomfortable completing some questions, you may request a phone meeting with the PGC leadership to discuss your concerns.

It can be challenging to think of (and remember) what may constitute a real or perceived COI. This survey will prompt you to think about your relationship(s) with commercial interests or government/not-for-profit organizations, including dates and topic areas of activities, and details about compensation. The following are some examples:

1. Employment relationships
2. Consulting relationships
3. Grants
4. Royalties
5. Stocks/stock options
6. Speaking engagements
7. Board and Committee memberships
8. Legal testimony
9. Research projects
10. Intellectual property, including patents