Living systematic reviews: 4. Living guideline recommendations

Living Systematic Review Network

Research output: Contribution to journalReview articlepeer-review

175 Scopus citations


While it is important for the evidence supporting practice guidelines to be current, that is often not the case. The advent of living systematic reviews has made the concept of “living guidelines” realistic, with the promise to provide timely, up-to-date and high-quality guidance to target users. We define living guidelines as an optimization of the guideline development process to allow updating individual recommendations as soon as new relevant evidence becomes available. A major implication of that definition is that the unit of update is the individual recommendation and not the whole guideline. We then discuss when living guidelines are appropriate, the workflows required to support them, the collaboration between living systematic reviews and living guideline teams, the thresholds for changing recommendations, and potential approaches to publication and dissemination. The success and sustainability of the concept of living guideline will depend on those of its major pillar, the living systematic review. We conclude that guideline developers should both experiment with and research the process of living guidelines.

Original languageEnglish (US)
Pages (from-to)47-53
Number of pages7
JournalJournal of Clinical Epidemiology
StatePublished - Nov 1 2017

Bibliographical note

Funding Information:
The authors would like to thank the members of the Living Systematic Reviews network for their comments on the paper, particularly Linn Brandt, Itziar Etxeandia, Kurinchi Gurusamy, Andrew Maas, Laura Martínez García, Stefania Mondello, Zachary Munn, Nicole Skoetz, Anneliese Synnot, Tari Turner, and Luke Wolfenden. We would like to acknowledge Cochrane Canada center and the GRADE center at McMaster University for financially supporting a meeting on the subject in May 2017. The Living Systematic Review Network is supported by funding from Cochrane and the Australian National Health and Medical Research Council (Partnership Project grant APP1114605).

Publisher Copyright:
© 2017 Elsevier Inc.


  • Living guidelines
  • Living systematic review
  • Prioritizing recommendations
  • Updating guidelines
  • Updating systematic reviews


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