Background: given the considerable efforts and resources required to develop health practice guidelines, developers need to prioritize the topics and questions to address.
Objective: this systematic review aims to identify and describe prioritization approaches in the development of clinical, public health, or health systems guidelines.
Methods: we searched the MEDLINE and CINAHL electronic databases. This was complemented with a manual search of Google Scholar, screening the reference lists of included and relevant papers, and forward citation tracking (up to March 2019). We included papers describing prioritization approaches in the development of health practice guidelines in sufficient detail to allow for reproducibility. We followed standard processes for study selection and data abstraction. We synthesized findings in a semi-quantitative way. We followed an iterative process of review and refinement to develop a common framework of prioritization criteria that captures all of the criteria reported by included studies.
Results: our search captured 23,722 unique citations, out of which we identified 10 papers reporting prioritization approaches for guideline development. All of the identified approaches focused on prioritizing guideline topics, but none on prioritizing recommendation questions or outcomes. The papers addressed the following areas: clinical practice (n = 7), public health (n = 1), healthcare recommendations for the World Health Organization (WHO) (n = 1), or more than one health area (n = 1). Two of the approaches stood out as being comprehensive and detailed. The two most frequently reported steps of the development process for the approaches were reviewing the grey literature (9 out of 10, 90%), and engaging various stakeholders (9 out of 10, 90%). All of the studies proposed the use of prioritization criteria, and most studies included the involvement of stakeholders as one aspect of prioritization (9 out of 10, 90%). We derived a common framework of 20 prioritization criteria that can be used when prioritizing guideline topics. The most frequently reported criteria were the public health burden of disease which was included in all of the approaches, practice variation (8 out of 10, 80%), and impact on health outcomes (7 out of 10, 70%).
Conclusions: we described 10 approaches in the development of guidelines. Our findings can assist clinicians, funders, policymakers, and other stakeholders seeking to develop guidelines in prioritizing topics to be addressed.
Patient or healthcare consumer involvement: this research highlights the need to involve patients and consumers in both, the development and conduct of prioritization for guideline development.