Background:
Clinical practice guidelines (CPGs) have become increasingly popular and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the selection and appraisal of the available literature. We conducted an international survey to identify current practices in CPGs updating, and explored the needs to standardize and improve the methods.
Methods:
A questionnaire (28 items) was designed based on a review of the existing literature about guideline updating and expert comments. The survey was carried out between March and July 2009 and was sent by e-mail to 106 institutions: 69 members of the Guidelines International Network who declared developing CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee.
Results:
Forty-four institutions answered the questionnaire (42% response rate). In the final analysis, 39 completed questionnaires were included. Thirty six institutions (92%) reported that they updated their guidelines. Thirty one institutions (86%) had a formal procedure for updating their guidelines and 19 (53%) had a formal procedure for deciding when a guideline becomes out of date. Institutions described the process as moderately rigorous (36%) or acknowledging that it could certainly be more rigorous (36%). Twenty two institutions (61%) alert guideline users on their website when a guideline is older than 3-5 years or when there is a risk of being outdated. Twenty five institutions (64%) supported the concept of ‘living guidelines’, which are continuously being monitored and updated. Eighteen (46%) had plans to design a protocol to improve their guideline updating process and 21 (54%) were willing to share resources with other organizations.
Conclusions:
Our study is the first international survey about the process of updating CPGs among prominent guideline institutions across the world, providing a comprehensive picture of guideline updating. There is an urgent need to develop rigorous international standards for this process, and to minimise duplication of effort internationally.