Development and translation into English of criteria for the prospective assessment of the need for updating guideline recommendations: AGIL-criteria

Article type
Authors
Braun C1, Harder T2, Kapp P3, Labonté V4, Mahler S3, Meerpohl J4, Nothacker M5, Piechotta V2, Prien P6, Schaefer C6, Schüler S6, Schwarz S6, Siemens W3
1Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
2Immunisation Unit, Robert Koch Institute, Berlin, Germany
3Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
4Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
5Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), c/o Philipps Universität Marburg/AWMF Berlin, Marburg, Germany
6German Agency for Quality in Medicine (ÄZQ), Berlin, Germany
Abstract
Background
The continuous updating of guideline recommendations may be important to inform healthcare decisions. However, resources for updating guidelines are often scarce.

Objectives
This project aimed to develop a set of criteria for prospectively identifying single-guideline recommendations that might require updates more frequently. We wanted these criteria to be used prospectively once a guideline is published to plan efficient use of available resources for keeping guideline recommendations up to date.

Methods
The AGIL-criteria (Assessment of Guidelines for Updating Recommendations) were developed through a multistep process involving experienced researchers and guideline developers: 1) defining a preliminary set of criteria considering previous literature; 2) surveying guideline experts on the initial criteria list; 3) revising the list based on survey results; 4) conducting a workshop at the conference of the Network for Evidence-based Medicine in 2023 to review and revise the criteria list; and 5) creating a final version by finding consensus in the author team and taking into account feedback from survey and workshop.

Results
Based on our 5-step approach, we incorporated the feedback of 176 guideline experts and about 30 workshop participants with experience in guideline development. This resulted in 3 AGIL-criteria, each consisting of 2 subitems a) and b): 1) relevance of the question regarding (a) PICO components and (b) other factors, eg, epidemiological aspects; 2) availability of new evidence (a) on health-related benefits and harms and (b) on other decision factors, eg, feasibility and acceptability; 3) impact of new evidence (a) on the certainty of evidence on which the recommendation is based and (b) on the present recommendation, eg, strength of recommendation.
Initially, the AGIL-criteria were developed in German. We will present an English translation of the AGIL-criteria and its supporting text at the conference and make them available on an open-access platform.

Conclusions
The AGIL-criteria offer a structured approach for prospectively evaluating the need to update single-guideline recommendations. The structured 5-step approach and involvement of numerous experts in both the survey and workshop strengthened the development process. We plan on implementing and evaluating the AGIL-criteria in an upcoming guideline.