gms | German Medical Science

Background: In contrast to numerous efforts to improve methods for guideline development, the process of updating guidelines has received less attention. Nonetheless, many guideline organizations seek to improve their updating process. We conducted a systematic review to gain insight in the currently available methods for updating guidelines and their strengths and limitations.

Methods: Electronic databases as well as conference reports were searched. Articles were included if they reported on procedures to decide when updating is necessary, described actual updating procedures and/or described experiences with them.

Results: Three procedures for guideline updating were reported. The 'traditional' approach proposes to update guidelines after predefined intervals, using similar methods as during the development of the original guideline. The 'pragmatic' approach includes regular literature searches limited to editorials and commentaries. The third approach uses the concept of 'iving guidelines' including regular literature searches based on the original search.

Discussion: All available methods for updating have strengths and limitations. Whether the less rigorous updating process in the pragmatic approach requires less resources is unclear, because it does not build on previous searches. The more rigorous process of living guidelines seems more appealing, because it builds on and preserves the validity of the original guideline.

Implications for guideline developers/users: Decisions about the optimal procedure for guideline updating should depend on the disease area covered by the guideline. In rapidly evolving areas, the continuous updating (living guideline) model seems preferable. In areas with less new developments, the pragmatic approach might be an adequate alternative.