Abstract
BackgroundWHO has recognised the need to ensure that guideline processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. Along with decision-making criteria that require findings from effectiveness reviews, WHO is increasingly using evidence derived from qualitative evidence syntheses (QES) to inform the values, acceptability, equity and feasibility implications of its recommendations. This is the first in a series of three papers examining the use of QES in developing clinical and health systems guidelines.MethodsWHO convened a group of methodologists involved in developing recent (2010–2018) guidelines that were informed by QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. Our aim in this paper is to (1) describe and discuss how the findings of QES can inform the scope of a guideline and (2) develop findings for key guideline decision-making criteria.ResultsQES resulted in the addition of new outcomes that are directly relevant to service users, a stronger evidence base for decisions about how much effective interventions and related outcomes are valued by stakeholders in a range of contexts, and a more complete database of summary evidence for guideline panels to consider, linked to decisions about values, acceptability, feasibility and equity.ConclusionsRigorously conducted QES can be a powerful means of improving the relevance of guidelines, and of ensuring that the concerns of stakeholders, at all levels of the healthcare system and from a wide range of settings, are taken into account at all stages of the process.
Highlights
with two more in preparation (WHO) has recognised the need to ensure that guideline processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable
Until recently, the decisions made by guideline panels about these criteria have been largely based on the expert opinion of guideline development groups at WHO and/or on evidence that they happen to know about or that has been collected ad hoc, rather than on a systematic review of relevant research [2]
The experiences, guidance and data presented in this series of papers are the result of a range of processes that have evolved over a decade of engagement with qualitative research in the context of developing healthcare guidelines at WHO
Summary
WHO has recognised the need to ensure that guideline processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. Along with decision-making criteria that require findings from effectiveness reviews, WHO is increasingly using evidence derived from qualitative evidence syntheses (QES) to inform the values, acceptability, equity and feasibility implications of its recommendations. This is the first in a series of three papers examining the use of QES in developing clinical and health systems guidelines. The WHO Handbook for Guideline Development was produced This stipulates that evidence of several criteria is required to inform a WHO guideline recommendation in addition to evidence of the effectiveness of an intervention [4]. Until recently, the decisions made by guideline panels about these criteria have been largely based on the expert opinion of guideline development groups at WHO and/or on evidence that they happen to know about or that has been collected ad hoc, rather than on a systematic review of relevant research [2]
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