Updated clinical guidelines: improving their methods and reporting

Abstract

Introduction_x000D_ Clinical guidelines (CGs) aim to guide healthcare professionals, patients, and policymakers in decision-making by providing recommendations for a healthcare problem. However, since new evidence is published on a regular basis, CGs may require to be updated in order to guarantee the validity of recommendations. As opposed to the methodology for developing de novo CGs, there is scarce guidance available for the updating process of CGs and little is known about the methodology that CG institutions use to maintain the validity of their CGs._x000D_ _x000D_ Objectives_x000D_ The objectives of this thesis are: 1) to identify and describe the updating guidance available in CG methodological handbooks, 2) to develop a checklist for the reporting of updated CGs, and 3) to assess the completeness of reporting of updated contemporary CGs._x000D_ _x000D_ Methods_x000D_ For the first study, we conducted a systematic review of CG methodological handbooks searching in MEDLINE, the Guidelines International Network (G-I-N), and the US National Guidelines Clearinghouse. Two authors independently selected evidence and extracted data. We used descriptive statistics and a narrative synthesis to analyse the extracted data._x000D_ _x000D_ For the second study, we developed a reporting instrument for the updating process of CGs. This tool was constructed through a multi-step development process that included an assessment of updated CGs, semi-structured interviews with key informants, a Delphi consensus survey, a single-round survey with CG methodologists, and semi-structured interviews with CG users._x000D_ _x000D_ For the third study, we systematically assessed the reporting of the updating process in updated CGs published in 2015. To be eligible, CGs had to be developed by a professional society, report a systematic review of the evidence, and contain at least one recommendation. Three reviewers independently applied the reporting instrument developed in the second study to the included CGs._x000D_ _x000D_ Results_x000D_ For the first study, we included 35 handbooks. Little guidance for updating CGs was identified. Most handbooks focused mainly on providing guidance for developing CGs de novo. The majority of the handbooks did not provide guidance for the literature search, evidence selection, quality assessment, evidence synthesis, or external review during the updating process. _x000D_ _x000D_ In the second study, we developed the Checklist for the Reporting of Updated Guidelines (CheckUp), which includes 16 items regarding: 1) the presentation of an updated guideline, 2) editorial independence, and 3) the methodology of the updating process. We also developed and explanation and elaboration document for CheckUp with the goal to facilitate the potential users._x000D_ _x000D_ In the last study, we included 60 updated CGs. The median overall score with CheckUp on a 10-point scale was 6.3 (range 3.1 to 10). The presentation and justification items at recommendation level and the methods for external review and implementing changes in practice were poorly reported. _x000D_ _x000D_ Conclusions_x000D_ The guidance available for the updating of CGs and the reporting of updated CGs is suboptimal. CheckUp is the first reporting instrument in the CG enterprise with a focus on the updating process. CheckUp can be used to assess the completeness of reporting of the updating process in updated CGs, and also guide CG panels by providing methodological and reporting principles that should be incorporated into the updating process.

Date of Award	16 Feb 2018
Original language	English
Supervisor	Pablo Alonso Coello (Director) & Laura Martínez García (Director)