Living systematic reviews: 4. Living guideline recommendations

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.

Breathing life into Australian diabetes clinical guidelines

“…This is achieved through monthly searches of key databases to identify recently published research. Following analysis of the new data, an impact assessment is conducted to determine whether the evidence is of sufficient relevance, reliability and importance to justify revising recommendations . Updated recommendations are then published within a real‐time digital dissemination platform, providing stakeholders with access to the most up‐to‐date version of the guideline.…”

Qualität in der Kopf-Hals-Onkologie

“…Im Mittel liegt die Aktualität der 20 publizierten Leitlinien des Leitlinienprogramms Onkologie bei 2,3 Jahren (Median 1,6 Jahre) [22]. Um immer die aktuelle Evidenz wiederzugeben, wären living guidelines optimal, also eine kontinuierliche Überprüfung und Aktualisierung von Leitlinien [23]. Diese würden eine ständige Aktualität der Leitlinien gewährleisten, jedoch auch einen immensen zeitlichen und organisatorischen Aufwand bedeuten.…”

Living systematic reviews, not only for clinical (placebo) research

“…In this context, we compared the cumulative incidence of second primary cancers (SPCs) estimated using different methods: (1) incidence proportion, calculated as ''the proportion of a closed population at risk that becomes diseased within a given period of time'' [4] (5 years for the entire sample and 10 years for a subsample); (2) 1-KM; and (3) cumulative incidence function introduced by Kalbfleisch and Prentice [5], which takes into account competing events. A population-based cohort of gastric first primary cancers (FPCs) from the North Region Cancer Registry of Portugal, diagnosed in 2000e2006, was followed to December 31, 2011, until the diagnosis of an SPC, or death, whichever occurred first [6].…”