Background: due to a continuous emergence of new evidence, clinical guidelines CGs require regular surveillance of evidence to maintain their trustworthiness. The updating of CGs is resource-intensive and time-consuming, therefore, CG developers could benefit from a prioritisation process for updating to efficiently use their resources.
Objectives: to develop a pragmatic tool, the UpPriority Tool, to prioritise clinical questions for updating within a CG.
Methods: we used a multistep process including:
1) establishment of the Working Group;
2) generation of the initial version of the tool;
3) optimization of the tool; and
4) approval of the final version of the tool.
To optimise the tool we conducted an initial feasibility test, semi-structured interviews, a Delphi consensus survey, a final feasibility test, an external review by guidelines developers and users, and a final pilot test.
Results: A total of 83 participants (mainly researchers with methodological experience in CG development and updating) contributed in the development process. The final version of the tool contains six items.
1) Impact of outdated recommendations on safety: evaluate whether potentially outdated recommendations have any implications on safety in the current CG healthcare context.
2) Availability of new relevant evidence: assess the availability of new relevant evidence related to the clinical question and recommendations.
3) Context relevance of the clinical question: review if the clinical question is still supported by factors of interest (burden of disease, variation in clinical practice, or emerging care options) in the current CG healthcare context.
4) Methodological applicability of the clinical question: review if the clinical question still addresses components of interest (population, intervention, comparison, and outcomes) in the current CG healthcare context.
5) Users’ interest: estimate the current interest (e.g. citations, downloads, news, debate, or website visits) on behalf of patients, healthcare providers, healthcare system, or other stakeholders related to the clinical question and recommendations.
6) Impact on access to health care: evaluate whether the recommendations have any implications on access and coverage in the current CG healthcare context.
The tool includes guidance for rating priority items, calculating and ranking priority scores, and reporting priority results and conclusions.
Conclusions: the UpPriority Tool could be useful for standardizing prioritization processes when updating CGs, and for fostering a more efficient use of resources in the CGs field. Different users (e.g. CGs, systematic review authors, or health technology assessment developers) could also adapt the tool according to their particular context's requirements.
Patient or healthcare consumer involvement: CGs' users were involved in the development of the tool (external review through semi-structured interviews). In addition, we will collect their feedback to continuously review and improve the tool.