The updating of clinical practice guidelines: insights from an international survey

Abstract

BackgroundClinical practice guidelines (CPGs) have become increasingly popular, and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the appraisal of the available literature. We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods.MethodsWe developed a questionnaire (28 items) based on a review of the existing literature about guideline updating and expert comments. We carried out the survey between March and July 2009, and it was sent by email to 106 institutions: 69 members of the Guidelines International Network who declared that they developed CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee.ResultsForty-four institutions answered the questionnaire (42% response rate). In the final analysis, 39 completed questionnaires were included. Thirty-six institutions (92%) reported that they update their guidelines. Thirty-one institutions (86%) have a formal procedure for updating their guidelines, and 19 (53%) have a formal procedure for deciding when a guideline becomes out of date. Institutions describe the process as moderately rigorous (36%) or acknowledge that it could certainly be more rigorous (36%). Twenty-two institutions (61%) alert guideline users on their website when a guideline is older than three to five years or when there is a risk of being outdated. Twenty-five institutions (64%) support the concept of "living guidelines," which are continuously monitored and updated. Eighteen institutions (46%) have plans to design a protocol to improve their guideline-updating process, and 21 (54%) are willing to share resources with other organizations.ConclusionsOur study is the first to describe the process of updating CPGs among prominent guideline institutions across the world, providing a comprehensive picture of guideline updating. There is an urgent need to develop rigorous international standards for this process and to minimize duplication of effort internationally.

The validity of recommendations from clinical guidelines: a survival analysis

“…5,6 Methodological handbooks include little guidance as to how to review and update guidelines, other than to do so periodically. 5,[7][8][9] Despite scant research, guideline programs endorse 3 to 5 years as a reasonable period after which guidelines should be reviewed. 5,10 This generic guidance is based on a study published more than 10 years ago that investigated how often guidelines needed to be updated.…”

Creating Clinical Practice Guidelines We Can Trust, Use, and Share

“…As a result, continuous or even timely updating is seldom undertaken; in rapidly evolving fi elds, guidelines become outdated quickly. 7,8 Moreover, the accessibility of guidelines for clinicians at the point of care is limited. Clinicians typically need to fi nd answers to their clinical questions within 2 min, and most such questions are likely to remain unanswered if clinicians need to track down and scroll through PDF fi les.…”

Reporting Items for Updated Clinical Guidelines: Checklist for the Reporting of Updated Guidelines (CheckUp)

“…The core group first developed an initial list of items—including explanation and examples—through brainstorming and discussion, taking into account (1) research evidence in the field [15,16,18], (2) the AGREE II Instrument [19], and (3) the panel experience. We used three core updating publications as a starting point from which the initial version of the checklist was generated [15,16,18].…”

“…However, there is no consensus about what is the optimal methodology to operationalise each of these steps or how to report on the process [5,14,15,16]; the available guidance from guideline institutions is suboptimal [17,18]. …”