Key quality considerations for advancing quality appraisal for living practice guidelines: A scoping review.

Abstract

The AGREE II, released in 2010, is an international gold standard for assessing the quality of guidelines. Since then, conceptual and methodological advancements in the field of livingness have emerged. The AGREE instrument requires updating to account for this progress. As a first step, a systematic search for concepts uniquely focused on livingness is required to identify potential new items, criteria, domains and examples. This scoping review was designed to identify key concepts that define the quality of the living aspect of living guidelines. Results of this review will inform new criteria, items, and domains that can be incorporated into the AGREE III. We searched electronic databases (Medline, EMBASE, Web of Science, and Scopus) from their inception until August 2024 for living guidelines and concept papers related to living guidelines. Eligible studies included concept papers which discussed living guidelines or evaluated livingness on any clinical health topic. Retrieved articles were screened in duplicate, and data were charted and synthesized using a deductive open coding approach. The resulting concepts were considered in the context of the existing AGREE II structure and as new items or domains. English language articles from any setting were considered eligible for inclusion. Thirty-five studies were eligible for inclusion. In total, 27 new concepts were created. Most of the new concepts aligned with the rigour of development domain and could be mapped as new items or new criteria to existing items. Key themes included justification of adopting a living approach, management of guideline questions and incorporation of new evidence throughout the living guideline cycle, continuous engagement and feedback from all relevant stakeholders, and ensuring appropriate and timely dissemination of guideline updates. Our findings highlight defining features of livingness that should be incorporated into the assessment of guideline quality. These will be tested as candidate AGREE III items and new criteria in subsequent stages of this program of research.