Prioritization methods in the development and adaptation of health practice guidelines: a systematic survey of published guidance

Article type
Authors
El-Harakeh A1, Chamseddine F2, Itani Z2, El Khoury R2, Khabsa J2, Ghaddar F1, Akl EA1
1American University of Beirut
2Clinical Research Institute, American University of Beirut Medical Center
Abstract
Background: Large variation exists in the implementation of prioritization exercises in the development of health practice guidelines. This underlines the importance of exploring available prioritization guidance and assess their level of comprehensiveness.

Objectives: To describe prioritization approaches proposed by a representative sample of guideline-producing organizations for the de novo development and adaptation of guidelines in the clinical, public health, and health systems fields.

Methods: We conducted a systematic survey to identify a comprehensive list of guideline-producing organizations and to compile publicly available methodological documents related to their prioritization processes. Teams of two reviewers worked independently and in duplicate to complete eligibility assessment and data abstraction. We collected data on the general characteristics of the organizations and on proposed prioritization steps and criteria. We adopted 11 categories of prioritization steps and 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. We consolidated findings in a semi-quantitative and narrative way.

Results: Our final sample consisted of 114 guideline-producing organizations. Most organizations were professional associations (62%), based in North America (45%), and from the clinical field (83%). While 76% of the identified guidance documents focused on prioritization in the de novo development of guidelines, 5% were on adaptation and 3% were on both. 65% of the guidance documents focused on prioritizing guideline topics, 4% on recommendation questions, and 13% on both, topics and questions. Prioritization of performance measures was addressed in 7% of the documents. For prioritization of topics, the most frequently reported steps were the generation of an initial list of topics (63%), mainly through expert opinion (90%), and the use of prioritization criteria (59%).

Conclusions: This survey included prioritization methods that addressed different prioritization steps for guideline development and adaptation. This can guide the work of researchers, funders, and other stakeholders seeking to prioritize guideline topics and questions.

Patient or healthcare consumer involvement: This research highlights the need to involve patients and consumers in the conduct of prioritization for the de novo development and adaptation of health practice guidelines.