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Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study
Carole Lunny1, Cynthia Ramasubbu1, Lorri Puil1
1Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada.
Introduction:
Assessing the process used to synthesize the evidence in clinical practice guidelines enables users to determine the trustworthiness of the recommendations. Clinicians are increasingly dependent on guidelines to keep up with vast quantities of medical literature, and guidelines are followed to avoid malpractice suits. We aimed to assess whether systematic methods were used when synthesizing the evidence for guidelines; and to determine the type of review cited in support of recommendations.
Methods:
Guidelines published in 2017 and 2018 were retrieved from the TRIP and Epistemonikos databases. We randomly sorted and sequentially screened clinical guidelines on all topics to select the first 50 that met our inclusion criteria. Our primary outcomes were the number of guidelines using either a systematic or non-systematic process to gather, assess, and synthesise evidence; and the numbers of recommendations within guidelines based on different types of evidence synthesis (systematic or non-systematic reviews). If a review was cited, we looked for evidence that it was critically appraised, and recorded which quality assessment tool was used. Finally, we examined the relation between the use of the GRADE approach, systematic review process, and type of funder.
Results:
Of the 50 guidelines, 17 (34%) systematically synthesised the evidence to inform recommendations. These 17 guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. Of the 29/50 guidelines that included reviews, 6 (21%) assessed the risk of bias of the review. The quality of primary studies was reported in 30/50 (60%) guidelines.
Conclusions:
High quality, systematic review products provide the best available evidence to inform guideline recommendations. Using non-systematic methods compromises the validity and reliability of the evidence used to inform guideline recommendations, leading to potentially misleading and untrustworthy results.
Insights
Most clinical practice guidelines do not use systematic methods for evidence synthesis. This impacts the trustworthiness of medical recommendations and clinician decision-making.
Area of Science:
- Clinical practice guidelines
- Evidence-based medicine
- Systematic reviews
Background:
- Clinical practice guidelines are essential for clinicians managing vast medical literature.
- Guidelines are increasingly relied upon to avoid malpractice.
- Assessing evidence synthesis methods determines recommendation trustworthiness.
Purpose of the Study:
- To assess systematic evidence synthesis in guidelines.
- To determine the type of review cited for recommendations.
Main Methods:
- Retrieved 50 guidelines from TRIP and Epistemonikos (2017-2018).
- Assessed evidence synthesis processes (systematic vs. non-systematic).
- Identified review types and critical appraisal methods used.
Main Results:
- Only 17% (34%) of guidelines used systematic evidence synthesis.
- Of guidelines citing reviews, 21% assessed review risk of bias.
- Primary study quality was reported in 60% of guidelines.
Conclusions:
- Systematic reviews provide high-quality evidence for guidelines.
- Non-systematic methods compromise evidence validity and trustworthiness.
- Ensuring systematic synthesis is crucial for reliable clinical recommendations.
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