The UpPriority tool was developed to guide the prioritization of clinical guideline questions for updating

Sanabria, Andrea Juliana; Pardo-Hernández, Héctor; Ballesteros, Mónica; Canelo‐Aybar, Carlos; McFarlane, Emma; Guzmán, Ena Niño de; Penman, Katrina; Posso, Margarita; Figuls, Marta Roqué i; Selva, Anna; Vernooij, Robin W.M.; Alonso‐Coello, Pablo; García, Laura Martínez; Agarwal, Arnav; Blanchard, Sophie; Brereton, Laura; Brouwers, Melissa; Etxeandia‐Ikobaltzeta, Itziar; Flórez, Iván D.; Haynes, Charlotte; Ibargoyen-Roteta, Nora; James, Roberta; Kwong, Joey S.W.; Minister, Claire; Nolan, Kay; Qaseem, Amir; Campo, Rafael Rotaeche del; Shaw, Beth; Shin, Ein Soon; Tam, Iris M.; Thornton, Judith; Per, Olav Vandvik

doi:10.1016/j.jclinepi.2020.06.018

Cited by 19 publications

(14 citation statements)

References 24 publications

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“…The research group of Martinez Garcia recently developed a tool to optimise the updating process, which shows great potential. However, in these mentioned proposals still all research questions need to be analysed ( Martínez García et al, 2017 ; Sanabria et al, 2021 ; Sanabria et al, 2020 ). The use of resources could be optimised if there would be no need to check the evidence for all existing key questions.…”

Section: Discussionmentioning

confidence: 99%

Efficiency based updating of evidence based surgical guidelines - Experiences from a multidisciplinary guideline upon Minimally Invasive Surgery

Tummers,

Coppus,

Lagerveld

et al. 2023

Facts Views Vis ObGyn

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Background: Updating evidence-based clinical practice guidelines is an onerous process and there is a call for more efficient determination of key questions that need updating. Especially for surgical techniques it is unclear if new evidence will result in substantial changes after wide implementation and if continuous updating is always necessary. Objectives: This study analyses the impact of updating a surgical guideline and proposes suggestions for optimising this process. Materials and methods: The Dutch Minimally Invasive Surgery guideline was developed in 2011 and updated in 2021. For both versions a multidisciplinary guideline working group (GDG) was created, that determined key questions. Changes in conclusions and recommendations were analysed by the GDG and statements for expected change of recommendations in the future were made. Results: 15 key questions were formed, of which 12 were updates of the previous guideline. For only 27% of the updated key questions, the conclusions changed. In ten years, the body grew only marginally for most key questions and quality of the evidence did not improve substantially for almost all key questions. However, in this first update of the MIC guideline, many recommendations did change due to a more robust interpretation of the conclusions by the GDG. Based on analysis of this updating process, the GDG expects that only four out of 15 recommendations may change in the future. Conclusion: We propose an additional step at the end of guideline development and updating, where the necessity for updating in the future is determined for each key question by the GDG, using their valuable knowledge gained from developing or updating the guideline. For surgical guidelines, the authors suggest updating key issues if it includes a relatively newly introduced surgical- or adapted technique or a new patient group. Low quality or small body of evidence should not be a reason in itself for updating, as this mostly does not lead to new evidence-based conclusions. This new step is expected to result in a more efficient prioritising of key questions that need updating. What’s new? By adding one additional step at the end of the updating process, the future updating process could become more efficient.

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Section: Discussionmentioning

confidence: 99%

Efficiency based updating of evidence based surgical guidelines - Experiences from a multidisciplinary guideline upon Minimally Invasive Surgery

Tummers,

Coppus,

Lagerveld

et al. 2023

Facts Views Vis ObGyn

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“…We designed an interview guide based on checklists previously developed by our group, and the experience obtained from the development of the RIGHT-Ad@pt checklist 22 26 27. The interview guide included four sections (online supplemental appendix 02): (1) characteristics of participants (country, experience in the field of health-related CGs and CG adaptation), (2) characteristics of participants’ CGs developing organisation, (3) participants’ experiences about current practice in the adaptation process and (4) participants’ views and experiences about challenges in the adaptation process.…”

Section: Methodsmentioning

confidence: 99%

Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews

Song

Ballesteros

et al. 2021

BMJ Open

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ObjectiveThis study aims to better understand the current practice of clinical guideline adaptation and identify challenges raised in this process, given that published adapted clinical guidelines are generally of low quality, poorly reported and not based on published frameworks.DesignA qualitative study based on semistructured interviews. We conducted a framework analysis for the adaptation process, and thematic analysis for participants’ views and experiences about adaptation process.SettingNine guideline development organisations from seven countries.ParticipantsGuideline developers who have adapted clinical guidelines within the last 3 years. We identified potential participants through published adapted clinical guidelines, recommendations from experts, and a review of the Guideline International Network Conference attendees’ list.ResultsWe conducted ten interviews and identified nine adaptation methodologies. The reasons for adapting clinical guidelines include developing de novo clinical guidelines, implementing source clinical guidelines, and harmonising and updating existing clinical guidelines. We identified the following core steps of the adaptation process (1) selection of scope and source guideline(s), (2) assessment of source materials (guidelines, recommendations and evidence level), (3) decision-making process and (4) external review and follow-up process. Challenges on the adaptation of clinical guidelines include limitations from source clinical guidelines (poor quality or reporting), limitations from adaptation settings (lacking resources or skills), adaptation process intensity and complexity, and implementation barriers. We also described how participants address the complexities and implementation issues of the adaptation process.ConclusionsAdaptation processes have been increasingly used to develop clinical guidelines, with the emergence of different purposes. The identification of core steps and assessment levels could help guideline adaptation developers streamline their processes. More methodological research is needed to develop rigorous international standards for adapting clinical guidelines.

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“…The UpPriority approach provides one way to determine when GRACE recommendations require updating and should be considered in the near future. 18 Together, GRACE challenges physicians to embrace the dynamic nature of medicine, prioritize the practical needs of clinicians, and catalyze the growth of pertinent emergency medicinefocused research, to ultimately yield better patient outcomes based on compelling research and guideline recommendations. It is when the evidence is sparse that rigorous clinical practice guidelines are needed and most helpful to illuminate unknowns and align strength of evidence with current practice.…”

Section: F I G U R Ementioning

confidence: 99%

“…Concurrently, GRACE will need to develop a transparent process by which to assess when prior GRACE guidelines require updating based on research that emerges after publication. The UpPriority approach provides one way to determine when GRACE recommendations require updating and should be considered in the near future 18 . Together, GRACE challenges physicians to embrace the dynamic nature of medicine, prioritize the practical needs of clinicians, and catalyze the growth of pertinent emergency medicine–focused research, to ultimately yield better patient outcomes based on compelling research and guideline recommendations.…”

Section: Figurementioning

confidence: 99%

Clinical relevance rather than evidence existence: The SAEM GRACE pragmatism

Oliveira J. e Silva,

Bellolio,

Carpenter

2024

Academic Emergency Medicine

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Just because you don't see something, doesn't mean it isn't there. The stars are always there.-R.C. LewisThe Institute of Medicine's "Clinical Practice Guidelines We Can Trust" defined clinical practice guidelines as "statements that include recommendations that are intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." 1 Traditionally, the path to constructing these guidelines has followed the trail of evidence. However, a shift has emerged, challenging the notion that crafting PICO (patient, intervention, comparison, outcome) questions in areas with existing evidence should be the sole compass for guideline development. Specifically, the paradigm shift is that contemporary guidelines should address dilemmas faced in practice rather than only topics where abundant evidence exists.

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The UpPriority tool was developed to guide the prioritization of clinical guideline questions for updating

Cited by 19 publications

References 24 publications

Efficiency based updating of evidence based surgical guidelines - Experiences from a multidisciplinary guideline upon Minimally Invasive Surgery

Efficiency based updating of evidence based surgical guidelines - Experiences from a multidisciplinary guideline upon Minimally Invasive Surgery

Current practices and challenges in adaptation of clinical guidelines: a qualitative study based on semistructured interviews

Clinical relevance rather than evidence existence: The SAEM GRACE pragmatism

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