Background: A systematic and transparent topic selection and prioritisation process, with specific criteria is a key step in guideline development (1).
Guidelines should address areas of clinical uncertainty shown by variation in practice or outcomes. Change should be possible and desirable there should be potential to improve patient outcomes. There must also be evidence of effective practice.
The existing SIGN topic proposal process allows for a broad scope Typical guidelines follow the patient pathway; diagnosis, treatment and follow up, and may contain many recommendations that reflect current practice.

Objectives: To develop a topic proposal process that:
• addresses uncertainties;
• is transparent; and,
• results in a guideline that leads to significant improvement in care.

Methods: A published topic-proposal template was adapted and developed by a multidisciplinary group. The process was piloted with a proposal on managing migraine. The pilot proposal was updated and posted on the SIGN website at every stage of the process. Feedback was sought on the process.

Results: A topic proposal template from WHO was adapted to local needs by adding screening tools, declaration of interests and search narrative (2). Proposers are asked to define three key questions in areas of clinical uncertainty. The projected time for guideline development is 15 months.

Conclusions: SIGN guidelines now focus on the important but challenging questions where uncertainty exists or the evidence requires careful evaluation. This means the guidelines have fewer key clinical questions but they are also likely to produce the greatest effect on practice.

1) Schunemann HJ, Wiercioch W, Etxeandia I, Falavigna M, Santesso N, Mustafa R, et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2014;186(3):E123-42. Epub 2013/12/18.
2) Organization WH. Estonian Handbook for Guidelines Development. Estonia: World Health Organization; 2011.