Guideline organizations' guidance documents paper 2: priority setting

In the development of practice guidelines, priority setting of topics, questions, and outcomes ensures relevance and resource efficiency. The objective of this study was to describe priority setting processes as described in guidance documents by guideline-producing organizations.

We conducted a descriptive summary of guideline-producing organizations' publicly available guidance documents on practice guideline development (eg, guideline handbooks). We screened guideline-producing organizations' documents and abstracted data in duplicate and independently. We abstracted data on the elements of the priority setting process, including generation of initial list, method or tool used in the priority setting process, use of priority setting criteria, and refinement.

Of the 133 identified organizations with publicly available guidance documents, 94 (71%) reported on a priority setting process for guideline development, with 16 also reporting on a priority setting process for guideline updating (12%). Most of the organizations addressed, in their guidance documents, topic priority setting (94%), whereas a minority addressed priority setting of questions (36%), outcomes (29%), implementation (12%), quality measures (15%), and future research (5%). In the guidance documents, generation of the initial list was the most addressed element for topics (88%), questions (65%) and outcomes (59%), followed by the use of criteria for topics (89%) and questions (59%), and refinement for outcomes (52%). A minority of organizations provided guidance to a published priority setting method or tool, which was only for topics (24%). The top used criteria for priority setting of topics were the impact of intervention on health outcomes (74%), variation/gaps in practice (69%), availability of evidence (69%), and disease health burden (68%); whereas for questions, top criteria were availability of evidence (60%), followed by interest at health professional/organization level (50%), uncertainty or controversy about best practice (40%), and variation/gaps in practice (40%).

This analysis of guideline-producing organizations revealed that a majority reported a priority-setting process, which primarily focused on topic selection and less on aspects like questions and outcomes. Although generating an initial list and using priority-setting criteria are common, few organizations report in their guidance documents using formal priority-setting tools, addressing refinement, or providing guidance for guideline updating or adaptation. A standardized priority setting process for all aspects of guideline development is needed.