Methods for living guidelines: early guidance based on practical experience. Paper 5: decisions on methods for evidence synthesis and recommendation development for living guidelines

David Fraile Navarro, Saskia Cheyne, Kelvin Hill, Emma McFarlane, Rebecca L. Morgan, M. Hassan Murad, Reem A. Mustafa, Shahnaz Sultan, David J. Tunnicliffe, Joshua P. Vogel, Heath White, Tari Turner

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objectives: Producing living guidelines requires making important decisions about methods for evidence identification, appraisal, and integration to allow the living mode to function. Clarifying what these decisions are and the trade-offs between options is necessary. This article provides living guideline developers with a framework to enable them to choose the most suitable model for their living guideline topic, question, or context. Study Design and Setting: We developed this guidance through an iterative process informed by interviews, feedback, and a consensus process with an international group of living guideline developers. Results: Several key decisions need to be made both before commencing and throughout the continual process of living guideline development and maintenance. These include deciding what approach is taken to the systematic review process; decisions about methods to be applied for the evidence appraisal process, including the use of unpublished data; and selection of “triggers” to incorporate new studies into living guideline recommendations. In each case, there are multiple options and trade-offs. Conclusion: We identify trade-offs and important decisions to be considered throughout the living guideline development process. The most appropriate, and most sustainable, mode of development and updating will be dependent on the choices made in each of these areas.

Original languageEnglish (US)
Pages (from-to)118-128
Number of pages11
JournalJournal of Clinical Epidemiology
StatePublished - Mar 2023

Bibliographical note

Funding Information:
This article was not funded. The National COVID-19 Clinical Evidence Taskforce is supported by: Australian Government Department of Health, Victorian Government Department of Health and Human Services, The Ian Potter Foundation, Walter Cottman Endowment Fund (managed by Equity Trustees), Lord Mayors’ Charitable Foundation. The Australian Evidence-Based Clinical Guidelines for Diabetes is supported by: Australian Diabetes Society, Diabetes Australia, Australian Diabetes Educators Association, Australasian Paediatric Endocrine Group and the Australian Government Department of Health. The Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis is supported by the Australian Government’s Value in Prescribing program grant, managed by the Targeted Therapies Alliance, a consortium coordinated by NPS MedicineWise.NICE receives funding from the Department of Health and Social Care in England.Work to complete the systematic reviews which informed the IDSA COVID-19 guidelines was primary funded by the IDSA with contribution from the Evidence Foundation.

Publisher Copyright:
© 2023 The Authors


  • Clinical practice guidelines
  • Evidence-based medicine
  • Living evidence
  • Living guidelines
  • Methods
  • Systematic reviews

PubMed: MeSH publication types

  • Journal Article


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