Considering sex, gender, and diversity in medical guidelines and evidence-based patient decision aids: concept development and pilot study

Article type
Authors
Berger-Höger B1, Hartig-Magulsky C1, Kaden J1, Kaufmann M2, Lauberger J3, Lühnen J4, Pechtel K2, Stanke S3, Steckelberg A3
1Institute for Public Health and Nursing Research, Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
2Institute of Anthropology and Cultural Research, Faculty of Cultural Studies, University of Bremen, Bremen, Germany
3Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
4Charité - Universitätsmedizin Berlin, Corporate Member Of Freie Universität Berlin And Humboldt Universität Zu Berlin, Berlin, Germany
Abstract
Background
Current medical guidelines in Germany have so far taken little account of aspects of sex, gender, and diversity, and they do not usually provide all the information that is needed for the development of evidence-based patient decision aids.
Objectives
The aim was to develop and pilot-test a concept for the development of guidelines and evidence-based patient decision aids considering sex, gender, and diversity.
Methods
Literature review: We reviewed method papers from national and international guideline organizations and conducted comprehensive literature searches. In an interdisciplinary research team, including patient representatives, we defined the dimensions of diversity used in our project.
Exploration: We conducted an online survey (249 scientific-medical societies) and semistructured interviews with people involved in guideline processes (11/2022–10/2023) to assess the process of selecting mandate holders, experiences, and attitudes regarding sex, gender, and diversity as well as the consideration of patients’ needs and preferences in guideline processes. Analyses included descriptive and content analyses.
Public consultation: The concept was published for public consultation in 12/2023 via OSF (https://osf.io/9yeku/).
Results
The survey (response rate 18%) and the interviews (n = 12) showed that sex, gender, and diversity have received little attention in the selection of mandate holders and guideline processes so far. The needs and preferences of the target group were not regularly assessed, and the involvement of patient representatives varies. Based on these results and the identified literature, we set up the first draft of the concept and revised it, taking into account the comments of the patient representatives.
The concept describes methods to extend the process for developing evidence-based guidelines to consider sex, gender, and diversity and patients’ needs and preferences as well as the content requirements of patient decision aids throughout the entire process. Additional materials, such as a checklist, toolkit, data extraction sheet, and template, for patient decision aids are provided.
Conclusions
We are currently reviewing the comments from the consultation phase. The pilot study with a guideline group is ongoing. After revision, the final concept will be made publicly accessible. In the long term, it may support guideline groups to improve knowledge transfer and promote health literacy as well as informed decisions.