Abstract
Objectives
Producing living guidelines requires making important decisions about methods for
evidence identification, appraisal, and integration to allow the living mode to function.
Clarifying what these decisions are and the trade-offs between options is necessary.
This article provides living guideline developers with a framework to enable them
to choose the most suitable model for their living guideline topic, question, or context.
Study Design and Setting
We developed this guidance through an iterative process informed by interviews, feedback,
and a consensus process with an international group of living guideline developers.
Results
Several key decisions need to be made both before commencing and throughout the continual
process of living guideline development and maintenance. These include deciding what
approach is taken to the systematic review process; decisions about methods to be
applied for the evidence appraisal process, including the use of unpublished data;
and selection of “triggers” to incorporate new studies into living guideline recommendations.
In each case, there are multiple options and trade-offs.
Conclusion
We identify trade-offs and important decisions to be considered throughout the living
guideline development process. The most appropriate, and most sustainable, mode of
development and updating will be dependent on the choices made in each of these areas.
Graphical abstract
Graphical Abstract
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
- 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
- WHO handbook for guideline development. World Health Organisation, Geneva, Switzerland2014
- SIGN50 A guideline developer’s handbook.Scottish Intercollegiate Guidelines Network, Edinburgh2019
- Clinical practice guidelines we can trust.National Academies Press(US), Washington, DC2011
- Living systematic reviews: 4. Living guideline recommendations.J Clin Epidemiol. 2017; 91: 47-53
- Decision makers need constantly updated evidence synthesis.Nature. 2021; 600: 383-385
- Strategies for monitoring and updating clinical practice guidelines: a systematic review.Implement Sci. 2012; 7: 1-10
- Australian guidelines for the clinical care of people with COVID-19.(Available at)https://covid19evidence.net.au/Date accessed: December 1, 2022
- Clinical care of children and adolescents with COVID-19: recommendations from the national COVID-19 clinical evidence taskforce.Med J Aust. 2022; 216: 255-263
- Clinical care of pregnant and postpartum women with COVID-19: living recommendations from the national COVID-19 clinical evidence taskforce.Aust N Z J Obstet Gynaecol. 2020; 60: 840-851
- Care of older people and people requiring palliative care with COVID-19: guidance from the Australian National COVID-19 Clinical Evidence Taskforce.Med J Aust. 2022; 216: 203-208
- Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Infectious Diseases Society of America,
2022 (Version 10.1.1. Available at)https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/Date accessed: January 21, 2023
- The infectious diseases society of America guidelines on the diagnosis of coronavirus disease 2019 (COVID-19): antigen testing.Clin Infect Dis. 2021; (ciaa1343)
- COVID-19 rapid guideline: managing COVID-19.(Available at)https://www.nice.org.uk/guidance/ng191Date accessed: May 11, 2022
- Feasibility of national living guideline methods: the Australian Stroke Guidelines.J Clin Epidemiol. 2022; 142: 184-193
- Management of cholesterol-lowering therapy for people with chronic kidney disease.CARI Guidelines, Sydney, Australia2021
- Australian Evidence-Based Clinical Guidelines for Diabetes.(Available at)https://diabetessociety.com.au/living-guidelines.aspDate accessed: December 1, 2022
- Living systematic review: 1. Introduction—the why, what, when, and how.J Clin Epidemiol. 2017; 91: 23-30
- How to write a Cochrane systematic review.Nephrology. 2010; 15: 617-624
- Assessing risk of bias in a randomized trial.Cochrane Handb Syst Rev Interv. 2019; : 205-228
- GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables.J Clin Epidemiol. 2011; 64: 383-394
- AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.BMJ. 2017; 358: j4008
- ROBIS: a new tool to assess risk of bias in systematic reviews was developed.J Clin Epidemiol. 2016; 69: 225-234
- Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews.J Clin Epidemiol. 2021; 130: 13-22
- HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis.Cochrane Database Syst Rev. 2014; : CD007784
- A text-mining framework for supporting systematic reviews.Am J Inf Manag. 2016 Nov; 1: 1-9
- Managing the evidence infodemic: Automation approaches used for developing NICE COVID-19 living guidelines.(Available at)https://www.medrxiv.org/content/10.1101/2022.06.13.22276242v1Date: 2022Date accessed: August 31, 2022
- Effect of Dexamethasone in Hospitalized Patients with COVID-19 – Preliminary Report.(Available at)
- Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results.(Available at)
- Peer review: a flawed process at the heart of science and journals.J R Soc Med. 2006; 99: 178-182
- Infectious Diseases Society of America guidelines on the diagnosis of coronavirus disease 2019.Clin Infect Dis. 2020; : ciaa760
- Covidence - Better systematic review management.(Available at)https://www.covidence.org/Date accessed: April 20, 2022
- DistillerSR | Systematic Review Software | Literature Review Software.(Available at)https://www.evidencepartners.com/products/distillersr-systematic-review-softwareDate accessed: May 4, 2022
- Rayyan—a web and mobile app for systematic reviews.Syst Rev. 2016; 5: 1-10
- EPPI-Reviewer: software for research synthesis.(Available at)https://discovery.ucl.ac.uk/id/eprint/10003909/1/Thomas2007EPPI-Reviewer%28Poster%29.pdfDate: 2007Date accessed: January 21, 2023
- GRADEpro.(Available at)https://www.gradepro.org/Date accessed: April 20, 2022
- MAGICapp.(Available at)https://magicevidence.org/magicapp/Date accessed: April 20, 2022
- A randomized trial provided new evidence on the accuracy and efficiency of traditional vs. electronically annotated abstraction approaches in systematic reviews.J Clin Epidemiol. 2019; 115: 77-89
- Adjudication rather than experience of data abstraction matters more in reducing errors in abstracting data in systematic reviews.Res Synth Methods. 2020; 11: 354-362
- The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366: l4898
- Evaluation of the inclusion of studies identified by the FDA as having falsified data in the results of meta-analyses: the example of the apixaban trials.JAMA Intern Med. 2019; 179: 582-584
Djulbegovic B, Ahmed MM, Hozo I, Koletsi D, Hemkens L, Price A, et al. High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence. J Eval Clin Pract. ;28(3):353-362.
- Updating meta-analyses leads to larger type I errors than publication bias.J Clin Epidemiol. 2009; 62: 825-830.e10
- Should Cochrane apply error-adjustment methods when conducting repeated meta-analyses?.(Available at)https://methods.cochrane.org/sites/methods.cochrane.org/files/uploads/tsa_expert_panel_guidance_and_recommendation_final.pdfDate accessed: December 1, 2022
- Living systematic reviews: 3. Statistical methods for updating meta-analyses.J Clin Epidemiol. 2017; 91: 38-46
- GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction.BMJ. 2016; 353: 166.e1-166.e10
- AGREE II: advancing guideline development, reporting and evaluation in health care.CMAJ. 2010; 182: E839-E842
- Weekly updates of national living evidence-based guidelines: methods for the Australian living guidelines for care of people with COVID-19.J Clin Epidemiol. 2021; 131: 11-21
- A framework for the development of living practice guidelines in health care.Ann Intern Med. 2022; 175: 1154-1160
Article info
Publication history
Published online: January 03, 2023
Accepted:
December 21,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
