Processes for updating guidelines: protocol for a systematic review [version 1; peer review: 1 approved with reservations]

Background: National Clinical Guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions. Clinical guidelines require updating to ensure validly of the recommendations contained within. The purpose of this systematic review is to describe the most recent guideline update processes, including prioritisation methods, used by international or national groups who provide methods guidance for developing and updating clinical guidelines. Methods: A combination of searching a pre-defined list of international and national organisations that provide methods guidance for developing and updating clinical guidelines, together with grey literature searching, will be undertaken to identify relevant handbooks. This will be supplemented by a systematic literature search of Medline (EBSCO), Embase (OVID) and The Cochrane Methodology Register. As guideline development methodology has evolved considerably, the overall search span for this systematic review will be the last 10-years (2011-2021). Publications eligible for inclusion are methodological handbooks that provide updating guidance, including prioritisation methods, for clinical practice guidelines and peer-reviewed articles that describe or have implemented updating guidance, including prioritisation methods. Using Covidence, two reviewers will independently review titles/abstracts and full texts. Where disagreements occur, discussions will be held to reach consensus and where necessary, a third reviewer will be involved. Methodological handbooks will be quality assessed (using the GIN-McMaster Guideline Development Checklist) independently by two reviewers and any disagreements will be resolved by deliberation, or if necessary, a third reviewer. Data will be extracted by one reviewer and checked for inaccuracies/omissions by a second. A narrative synthesis will be undertaken. Conclusions: Updating clinical guidelines is an iterative process that is both resource intensive and time-consuming. The findings of this systematic review will support clinical guideline developers to ensure appropriate investment of resources.