Prioritization approaches in the development of health practice guidelines: a systematic review

Abstract

Background Given the considerable efforts and resources required to develop practice guidelines, developers need to prioritize what topics and questions to address. This study aims to identify and describe prioritization approaches in the development of clinical, public health, or health systems guidelines. Methods We searched Medline and CINAHL electronic databases in addition to Google Scholar. We included papers describing prioritization approaches in sufficient detail allowing for reproducibility. We synthesized findings in a semi-quantitative way. We followed an iterative process to develop a common framework of prioritization criteria that captures all of the criteria reported by each included study. Results Our search captured 33,339 unique citations out of which we identified 10 papers reporting prioritization approaches for guideline development. All of the identified approaches focused on prioritizing guideline topics but none on prioritizing recommendation questions or outcomes. The two most frequently reported steps of the development process for these approaches were reviewing the grey literature (9 out of 10, 90%) and engaging various stakeholders (9 out of 10, 90%). We derived a common framework of 20 prioritization criteria that can be used when prioritizing guideline topics. The most frequently reported criteria were the health burden of disease which was included in all of the approaches, practice variation (8 out of 10, 80%), and impact on health outcomes (7 out of 10, 70%). Two of the identified approaches stood out as being comprehensive and detailed. Conclusions We described 10 prioritization approaches in the development of health practice guidelines. There is a need to assess the effectiveness, efficiency and transparency of the identified approaches and to develop standardized and validated priority setting tools.

The implementation of prioritization exercises in the development and update of health practice guidelines: A scoping review

“…• Prioritization criteria; we used a common framework of prioritization criteria that we developed for a recent systematic review on prioritization approaches in the development of health practice guidelines [24] (see S5 File).…”

“…A recent systematic review highlighted the opportunity to engage diverse types of stakeholders in prioritizing guideline topics [24]. Incorporating views of various stakeholders in guideline development can potentially reduce a biased selection of topics by few groups and increase transparency [7,31].…”

Contextual differences considered in the Tunisian ADOLOPMENT of the European Guidelines on Breast Cancer Screening

“…The team then conducted a priority setting exercise to prioritize one of those topics. [13,14] The factors considered for priority setting included: public health burden; avoidable mortality and morbidity; economic burden on the health care system and patient; emerging diseases or emerging care options; potential impact of intervention on health outcomes, economy, health care system, and equity; variation in clinical practice; and rapidly changing evidence. [13,14] Eventually, the project team prioritized the topic of breast cancer screening as it was rated the highest.…”

Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

“…In fact, following a recent review of prioritisation exercises in published guidelines [10,11], the authors identified 11 steps of prioritisation that were used by guideline developers and noted that these steps are used inconsistently across published studies [10,11].…”

“…In fact, following a recent review of prioritisation exercises in published guidelines [ 10 , 11 ], the authors identified 11 steps of prioritisation that were used by guideline developers and noted that these steps are used inconsistently across published studies [ 10 , 11 ]. This lack of a standardised process may produce guidelines that are not relevant for end-users or do not address their clinical needs.…”