Abstract
While it is important for the evidence supporting practice guidelines to be current,
that is often not the case. The advent of living systematic reviews has made the concept
of “living guidelines” realistic, with the promise to provide timely, up-to-date and
high-quality guidance to target users. We define living guidelines as an optimization
of the guideline development process to allow updating individual recommendations
as soon as new relevant evidence becomes available. A major implication of that definition
is that the unit of update is the individual recommendation and not the whole guideline.
We then discuss when living guidelines are appropriate, the workflows required to
support them, the collaboration between living systematic reviews and living guideline
teams, the thresholds for changing recommendations, and potential approaches to publication
and dissemination. The success and sustainability of the concept of living guideline
will depend on those of its major pillar, the living systematic review. We conclude
that guideline developers should both experiment with and research the process of
living guidelines.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical EpidemiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical practice guidelines we can trust.(Washington (DC) National Academies Press)2011
- GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations.J Clin Epidemiol. 2013; 66: 719-725
- GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: clinical practice guidelines.BMJ. 2016; 353: i2089
- GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction.BMJ. 2016; 353: i2016
- Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.CMAJ. 2014; 186: E123-E142
- Knowledge, attitudes, beliefs, values, preferences, and feasibility in relation to the use of injection safety devices in healthcare settings: a systematic review.Health Qual Life Outcomes. 2016; 14: 102
- Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of chest Physicians evidence-based clinical practice guidelines.Chest. 2012; 141: e1S-e23S
- How quickly do systematic reviews go out of date? A survival analysis.Ann Intern Med. 2007; 147: 224-233
- Durability of class I American College of Cardiology/American Heart association clinical practice guideline recommendations.JAMA. 2014; 311: 2092-2100
- The validity of recommendations from clinical guidelines: a survival analysis.CMAJ. 2014; 186: 1211-1219
- Median life span of a cohort of National Institute for Health and Care Excellence clinical guidelines was about 60 months.J Clin Epidemiol. 2014; 67: 52-55
- The updating of clinical practice guidelines: insights from an international survey.Implement Sci. 2011; 6: 107
- Four Questions with Dr. Richard Irwin on CHEST Living Guidelines.2016 (Available at)http://www.chestnet.org/News/Blogs/CHEST-Thought-Leaders/2016/01/Dr-Richard-Irwin-on-CHEST-Living-GuidelinesDate accessed: December 9, 2017
Brain Trauma Foundation. Living Guidelines Update July 7 2016. Available at https://www.braintrauma.org/news/article/guidelines-update. Accessed on September 9, 2017.
INSIGHT Research. Living Guideline Group: keeping the Autism Spectrum Guideline up to date Sep 9, 2016. Available at http://www.health.govt.nz/our-work/disability-services/disability-projects/autism-spectrum-disorder-guideline/living-guideline-group-keeping-asd-guideline-date. Accessed on September 9, 2017.
- Keeping cancer guidelines current: results of a comprehensive prospective literature monitoring strategy for twenty clinical practice guidelines.Int J Technol Assess Health Care. 2003; 19: 646-655
- Pregnancy Clinical Guideline Updating Working G. Continuous surveillance of a pregnancy clinical guideline: an early experience.Syst Rev. 2017; 6: 143
- Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks.Implement Sci. 2014; 9: 3
- GRADE handbook for grading quality of evidence and strength of recommendation.(Version SA) McMaster University, GRADE Working Group, Hamilton, Ontario, Canada2011 ([Updated October 2013]. Available at)http://gdt.guidelinedevelopment.org/app/handbook/handbook.htmlDate accessed: December 9, 2017
- Methodological systematic review identifies major limitations in prioritisation processes for updating.J Clin Epidemiol. 2017; 86: 11-24
- GRADE guidelines: 12. Preparing summary of findings tables-binary outcomes.J Clin Epidemiol. 2013; 66: 158-172
- GRADE guidelines: 13. Preparing summary of findings tables and evidence profiles-continuous outcomes.J Clin Epidemiol. 2013; 66: 173-183
- Parenteral anticoagulation in ambulatory patients with cancer.Cochrane Database Syst Rev. 2017; 9: CD006652
- Enabling living systematic reviews and clinical guidelines through semantic technologies.Dlib Mag. 2015; 21 (Available at)
- Two methods provide similar signals for the need to update systematic reviews.J Clin Epidemiol. 2012; 65: 660-668
- Assessment of a method to detect signals for updating systematic reviews.Syst Rev. 2014; 3: 13
- Reporting items for updated clinical guidelines: checklist for the Reporting of updated guidelines (CheckUp).PLoS Med. 2017; 14: e1002207
- A Reporting tool for practice guidelines in health care: the RIGHT statement.Ann Intern Med. 2017; 166: 128-132
- Updated recommendations: an assessment of NICE clinical guidelines.Implement Sci. 2014; 9: 72
- Versioning computer-interpretable guidelines: semi-automatic modeling of ‘Living Guidelines’ using an information extraction method.Artif Intell Med. 2009; 46: 55-66
Article Info
Publication History
Published online: September 10, 2017
Accepted:
August 17,
2017
Footnotes
Conflicts of interest: The authors declare no financial conflict of interest. They are all interested in the field of living guidelines and involved in projects to develop living guidelines.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
