Systematic review of the methodological literature for integrating qualitative evidence syntheses into health guideline development

Abstract

Guidelines produced by local, national and international bodies underpin clinical practice and healthcare services worldwide. For guidelines to be based on the best available evidence, it is critical that syntheses of both qualitative and quantitative evidence are used to inform decision‐making. As methods for qualitative evidence syntheses (QES) develop, they are increasingly able to inform health guideline production. However, the process whereby this form of evidence is considered and incorporated tends to be unclear. This systematic review synthesized existing guidance concerning the use of QES in guideline development. Sources published in English that described or prescribed methods for incorporating QES into evidence‐based health guidelines were eligible for inclusion. Seventeen relevant papers were identified. The literature indicates that there is a reasonable consensus about many stages of conducting a QES to inform guideline development. Areas needing further exploration include: the way that committees engage with QES; the usefulness of different QES methodologies; and understanding of how expert committees use evidence. Methods for producing QES for guideline committees tend to be similar to quantitative systematic review methods in terms of searching, quality appraisal, systematic management of data, and presentation of results. While this allows transparency and accountability, it could be argued that it is less “true” to the principles of being led by the data, which are fundamental to most qualitative research. Understanding the process of using QES to produce guidelines is critical to determining their validity and applicability, and to ensure that healthcare provision is based on the best available evidence.

The move towards living systematic reviews and living guidelines in healthcare: consideration of the possibilities and challenges for living qualitative evidence syntheses

“…Since 2004, there has been a Cochrane Methods Group tasked with advising the Cochrane Collaboration on policy related to the synthesis of qualitative evidence and the integration of qualitative evidence with Cochrane effectiveness reviews. More recently, QES has become a part of the process of developing evidence-based health guidelines by organizations such as the UK National Institute for Health and Care Excellence (NICE) and by the World Health Organization (WHO) where they have been used by guideline panels to support their decision making [2][3][4]. This incorporation of QES into health guidelines has been made easier both by methodological developments in the ways that QES are undertaken (for example the introduction of GRADE CERQual [5]), and a drive by guidelineproducing organisations to consider the effects of patient preference, feasibility and acceptability on the broader effectiveness of a treatment or intervention when making guideline recommendations [3].…”