Methods for living guidelines: paper 6: insights from Australian Living Evidence Collaboration's (ALEC) use of...

Using published peer-reviewed systematic reviews are in theory an efficient way of establishing the evidence base for a guideline, however barriers to their optimal use exist. This article presents suggestions for assessing a published systematic reviews and determining its capacity to act as the evidence base primarily for the first version of a living guideline. Practical examples, based on the experiences of the Australian Living Evidence Collaboration (ALEC), are provided.

Members of ALEC were interviewed regarding their approach to using published systematic reviews when developing a living guideline. Interview data were synthesized and used to formulate suggestions for using published systematic reviews in the development of a living guideline and examples were identified.

Before using an existing systematic review for a living guideline, developers need to consider the suitability and quality of the review. Suitable reviews should have a relevant scope, transparent reporting, and appropriate search methods. Without these criteria being met, the review is unlikely to be of value. Ideally the review should also be recent, have critically appraised the included studies, and clearly present study level data. Where this has not been done, guideline developers may need to undertake additional work to remedy these limitations.

While existing systematic reviews have the potential to reduce the workload associated with collating the evidence base for a living guideline, barriers exist to their optimal use. Guideline developers should thoroughly assess the review for its suitability.

Clinical practice guidelines should be based on the best available evidence, and living guidelines should stay up to date as new studies are published. Undertaking a review of all the studies related to a guideline topic is a lot of work. Using an existing review of the literature, that has already been published, can help reduce this workload. We conducted interviews with experienced guideline developers to see how they use existing evidence reviews to make their living guidelines. Based on these interviews, we suggest how to best use an existing review to create a living guideline. This includes locating an appropriate review with a relevant scope, checking for clear reporting, and if the right studies were included. If a review does not meet these appropriate criteria, it is unlikely to be of value to form a living guideline. Ideally the review should also be recent, have considered the quality of the included studies, and clearly present the results of each study it included. If this has not been done, guideline developers may need to undertake additional work to use the review.