Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks

Implementation Science

Laura Martínez García¹  Pablo Alonso-Coello¹  Ivan Sol๠ Andrea Juliana Sanabria¹  Robin WM Vernooij² 

[1] Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau), C/ Sant Antoni Maria Claret 167, Barcelona 08025, Spain;Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands

关键词: Systematic review;    Methodology;    Handbooks;    Evidence-based medicine;    Clinical practice guidelines;   

Others  :  810627
DOI  :  10.1186/1748-5908-9-3

 received in 2013-06-12, accepted in 2013-12-19,  发布年份 2014

【 摘 要 】

Background

Updating clinical practice guidelines (CPGs) is a crucial process for maintaining the validity of recommendations. Methodological handbooks should provide guidance on both developing and updating CPGs. However, little is known about the updating guidance provided by these handbooks.

Methods

We conducted a systematic review to identify and describe the updating guidance provided by CPG methodological handbooks and included handbooks that provide updating guidance for CPGs. We searched in the Guidelines International Network library, US National Guidelines Clearinghouse and MEDLINE (PubMed) from 1966 to September 2013. Two authors independently selected the handbooks and extracted the data. We used descriptive statistics to analyze the extracted data and conducted a narrative synthesis.

Results

We included 35 handbooks. Most handbooks (97.1%) focus mainly on developing CPGs, including variable degrees of information about updating. Guidance on identifying new evidence and the methodology of assessing the need for an update is described in 11 (31.4%) and eight handbooks (22.8%), respectively. The period of time between two updates is described in 25 handbooks (71.4%), two to three years being the most frequent (40.0%). The majority of handbooks do not provide guidance for the literature search, evidence selection, assessment, synthesis, and external review of the updating process.

Conclusions

Guidance for updating CPGs is poorly described in methodological handbooks. This guidance should be more rigorous and explicit. This could lead to a more optimal updating process, and, ultimately to valid trustworthy guidelines.

【 授权许可】

   
2014 Vernooij et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]IOM (Institute of Medicine): Clinical Practice Guideline We Can Trust. Washington, DC: The National Academies Press; 2011.
• [2]Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004, 8(6):1-72.
• [3]Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J: Clinical guidelines: potential benefits, limitations and harms of clinical guidelines. BMJ 1999, 318(7182):527-530.
• [4]European Observatory on Health Systems and Policies: Clinical guidelines for chronic conditions in the European Union. Geneva: World Health Organisation; 2013.
• [5]Working Group on CPG Updates: Updating Clinical Practice Guidelines in the Spanish National Health System: Methodology Handbook. Madrid: National Plan for the National Health System of the Spanish Ministry for Health and Social Policy; Aragon Health Sciences Institute (I+CS); 2009.
• [6]National Institute for Health and Clinical Excellence: The guidelines manual. London: National Institute for Health and Clinical Excellence. 2012.
• [7]Shekelle P, Woolf S, Grimshaw JM, Schünemann HJ, Eccles MP: Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development. Implement Sci 2012, 7:62. BioMed Central Full Text
• [8]Martínez Garcia L, Arévalo-Rodríguez I, Solà I, Haynes RB, Vandvik PO, Alonso-Coello P, Updating Guidelines Working Group: Strategies for monitoring and updating clinical practice guidelines: a systematic review. Implement Sci 2012, 7(1):109. BioMed Central Full Text
• [9]Shekelle P, Eccles MP, Grimshaw JM, Woolf SH: When should clinical guidelines be updated? BMJ 2001, 323(7305):155-157.
• [10]Banzi R, Cinquini M, Liberati A, Moschetti I, Pecoraro V, Tagliabue L, Moja L: Speed of updating online evidence based point of care summaries: prospective cohort analysis. BMJ 2011, 343:d5856.
• [11]Gartlehner G, West SL, Lohr KN, Kahwati L, Johnson JG, Harris RP, Whitener L, Voisin CE, Sutton S: Assessing the need to update prevention guidelines: a comparison of two methods. Int J Qual Health Care 2004, 16(5):399-406.
• [12]Alonso-Coello P, Martínez García L, Carrasco Gimeno JM, Solà I, Qureshi S, Burgers JS, Díaz del Campo P, Estrada MD, Gracia J, Mengual J, Rico Iturrioz R, Rotaeche del Campo R, Salcedo-Fernandez F: The updating of clinical practice guidelines: insights from an international survey. Implement Sci 2011, 6:107. BioMed Central Full Text
• [13]Shekelle P, Ortiz E, Rhodes S, Morton SC, Eccles MP, Grimshaw JM, Woolf SH: Validity of the agency for healthcare research and quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA 2001, 286(12):1461-1467.
• [14]Scottish Intercollegiate Guidelines Network: SIGN 50: A guideline developer’s handbook. Edinburgh: Scottish Intercollegiate Guidelines Network; 2011.
• [15]Brouwers M, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna SE, Littlejohns P, Makarski J, Zitzelsberger L, AGREE Next Steps Consortium: AGREE II: advancing guideline development, reporting and evaluation in healthcare. CMAJ 2010, 182:839-842.
• [16]Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A: GRADE guidelines: a new series of articles in the journal of clinical epidemiology. J Clin Epidemiol 2011, 64(4):380-382.
• [17]Kung J, Miller RR, Mackowiak PA: Failure of clinical practice guidelines to meet institute of medicine standards: two more decades of little, if any, progress. Arch Intern Med 2012, 172(21):1628-1633.
• [18]Alonso-Coello P, Irfan A, Solà I, Gich I, Delgado-Noguera M, Rigau D, Tort S, Bonfill X, Burgers J, Schunemann H: The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care 2010, 19(6):e58.
• [19]Turner T, Misso M, Harris C, Green S: Development of evidence-based clinical practice guidelines (CPGs): comparing approaches. Implement Sci 2008, 3:45. BioMed Central Full Text
• [20]Ansari S, Rashidian A: Guidelines for guidelines: are they up to the task? A comparative assessment of clinical practice guideline development handbooks. PLoS One 2012, 7(11):e49864.
• [21]de Santé HA: Élaboration de recommandations de bonne pratique. Saint-Denis: Haute Autorité de Santé; 2010.
• [22]Centrul Naţional de Studii Medicina Familiei: Metodologie elaborarii ghidului de practica. http://www.ghidurimedicale.ro/index.php?option=com_content&task=view&id=19&Itemid=27 webcite. (accessed 1 August 2012)
• [23]Kwaliteitsinstituut voor de Gezondheidszorg CBO: Evidence-based Richtlijnontwikkeling Handleiding voor werkgroepleden. Utrecht: Kwaliteitsinstituut voor de Gezondheidszorg; 2007.
• [24]Van Der WP, Mead J: Framework for Clinical Guideline Development in Physiotherapy. Limassol: European Region of the World Confederation for Physical Therapy; 2004.
• [25]Agència d'Avaluació de Tecnologia i Recerca Mèdiques: Guies de pràctica clínica. http://www.gencat.cat/salut/depsan/units/aatrm/html/ca/dir252/doc7841.html webcite (accessed 3 August 2012)
• [26]Schubert I, Lelgemann M, Kirchner H, von Ferber C, von Ferber L, Ollenschläger G: Handbuch zur Entwicklung regionaler Leitlinien. Berlin: Ärztliches Zentrum für Qualität in der Medizin; 2006.
• [27]Arzneimittelkommission der deutschen Ärzteschaft: Leitfaden für die Erstellung von Therapieempfehlungen. Berlin: Arzneimittelkommission der deutschen Ärzteschaft; 2011.
• [28]Bundesärztekammer: National Disease Management Guidelines. Berlin: Bundesärztekammer; 2002.
• [29]Dumonceau JM, Hassan C, Riphaus A, Ponchon T: European society of gastrointestinal endoscopy (ESGE) guideline development policy. Endoscopy 2012, 44(6):626-629.
• [30]Iorio A, Ageno W, Cosmi B, Imberti D, Lussana F, Siragusa S, Tormene D, Tosetto A, Cattaneo M: Objectives and methodology: guidelines of the Italian society for haemostasis and thrombosis (SISET). Thromb Res 2009, 124(5):1-5.
• [31]Ärztliche Zentralstelle Qualitätssicherung: National Disease Management Guidelines: Method Report. Köln: Ärztliche Zentralstelle Qualitätssicherung; 2002.
• [32]Kunnamo I: Preface: What is Evidence-Based Medicine Guidelines. 2008. [Duodecim Medical Publications Ltd]
• [33]Society DFM: Submitted NHS Evidence Accreditation Application. Helsinki: Duodecim Finnish Medical Society; 2001.
• [34]Chevalier P, de Sutter A, Dirven K, Paulus D, Peremans L, van Royen P, van Welde A: Algemeen Stramien voor de Ontwikkeling van Aanbevelingen van Goede Medische Praktijkvoering. Antwerpen: Domus Medical Flemish College of General Practitioners; 2007.
• [35]World Health Organization: Guidelines for WHO Guidelines. Geneva: World Health Organization; 2003.
• [36]National Health and Medical Research Council: A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: National Health and Medical Research Council; 1998.
• [37]American Society of Clinical Oncology: American Society of Clinical Oncology Guideline Procedures Manual. Alexandria: American Society of Clinical Oncology; 2001.
• [38]Rosenfeld RM, Shiffman RN, Robertson P: Clinical practice guideline development manual, third edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg 2013, 148(1 Suppl):S1-S55.
• [39]Harris JS, Sinnott PL, Holland JP, Ording J, Turkelson C, Weiss M, Hegmann KT: Methodology to update the practice recommendations in the American college of occupational and environmental medicine’s occupational medicine practice guidelines, Second Edition. J Occup Environ Med 2008, 50(3):282-295.
• [40]Qaseem A, Snow V, Owens DK, Shekelle P: The development of clinical practice guidelines and guidance statements of the American college of physicians: summary of methods. Ann Intern Med 2010, 153(3):194-199.
• [41]American Urological Association Education and Research: Overview: Standard Operating Procedures. Linthicum: American Urological Association; 2011.
• [42]Guidelines and Protocols Advisory Committee: GPAC Handbook. Victoria: Guidelines and Protocols Advisory Committee; 2011.
• [43]U.S. Preventive Services Task Force: U.S. Preventive Services Task Force Procedure Manual. Rockville: Agency for Healthcare Research and Quality; 2008.
• [44]American College of Cardiology Foundation and American Heart Association: Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines. Washington DC: American College of Cardiology Foundation; 2010.
• [45]Joanna Briggs Institute Synthesis Science Unit: Best Practice Information Sheet (BPIS) Procedures. Adelaide: Joanna Briggs Institute;
• [46]Canadian Medical Association: Handbook on Clinical Practice Guidelines. Ottawa: Canadian Medical Association; 2007.
• [47]Therapeutic Guidelines Limited: How Therapeutic Guidelines are produced. http://www.tg.org.au/?sectionid=81 webcite (accessed 3 August 2012)
• [48]Caring for Australasians with Renal Impairment: A Guide for Writers. Concord: Caring for Australasians with Renal Impairment; 2009.
• [49]New Zealand Guidelines Group: Handbook for the Preparation of Explicit Evidence-base Clinical Practice Guidelines. Wellington: New Zealand Guidelines Group; 2001.
• [50]Gupta S, Bhattacharyya OK, Brouwers MC, Estey EA, Harrison MB, Hernandez P, Palda VA, Boulet LP: Canadian thoracic society: presenting a new process for clinical practice guideline production. Can Respir J 2009, 16(6):62-68.
• [51]American College of Chest Physicians: Methodology. http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/Methodology webcite (accessed 3 August 2012)
• [52]Murad MH, Montori VM, Sidawy AN, Ascher E, Meissner MH, Chaikof EL, Gloviczki P: Guideline methodology of the society for vascular surgery including the experience with the GRADE framework. J Vasc Surg 2011, 53(5):1375-1380.