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Sex and gender considerations in Canadian clinical practice guidelines: a systematic review
Cara Tannenbaum1, Barbara Clow1, Margaret Haworth-Brockman1
1Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man.
Background:
The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which this evidence is integrated into clinical practice guidelines remains unknown. We aimed to determine the proportion of Canadian clinical practice guidelines that integrate evidence on sex and gender considerations.
Methods:
We searched the Canadian Medical Association's CPG Infobase, PubMed, all provincial/territorial websites and websites of professional organizations for English- and French-language Canadian clinical practice guidelines published between January 2013 and June 2015 on selected conditions identified as priorities by policy-makers and practitioners. Citations and text were searched electronically using keyword terms related to sex and gender. Three investigators independently analyzed and categorized the content of text-positive clinical practice guidelines based on clinical relevance for practitioners.
Results:
Of the 118 clinical practice guidelines that met the inclusion criteria, 79 (66.9%) were text-positive for sex and/or gender keywords; 8 (10%) of the 79 used the keywords only in relation to pregnancy. Of the remaining 71 guidelines, 25 (35%) contained sex-related diagnostic or management recommendations. An additional 5 (7%) contained recommendations for sex-specific laboratory reference values, 29 (41%) referred to differences in epidemiologic features or risk factors only, and 12 (17%) contained nonrelevant mentions of search keywords. Twenty-five (35%) of the text-positive guidelines used the terms "sex" and/or "gender" correctly.
Interpretation:
Recommendations related to sex and gender are inconsistently reported in Canadian clinical practice guidelines. Guidelines such as the Sex and Gender Equity in Research guidelines may help inform the meaningful inclusion of sex and gender evidence in the development of clinical practice guidelines.