gms | German Medical Science

Background: The inequality in health between the rich and poor, observed in all countries, which is unnecessary and avoidable has been termed health inequity. Clinical guideline developers have an obligation to consider equity. How can developers ensure that equity is addressed in the recommendations they produce?

Context: As part of the NICE guideline development process, external stakeholders such as hospital trusts and Royal Colleges are encouraged to submit comments and queries on recommendations prior to publication. This can lead to reconsideration of recommendations to ensure that equity issues are adequately addressed. We aim to explore whether stakeholders believe equity is appopriately addressed in NICE clinical guidelines, and to suggest ways to improve this at the pre-publication stage.

Description of best practice: We will present examples from NICE guidelines where stakeholder comments regarding equity issues have led to changes in clinical recommendations with a potentially large impact on service provision. We will explore how equity was considered in the recommendations of these guidelines, and how pre-publication stakeholder comments affected the consideration of equity issues. We will also examine which types of stakeholders provide useful feedback regarding equity.

Lessons for guideline developers, adaptors, implementers, and/or users: The main lesson is how to use external bodies to ensure that guidelines address equity appropriately. We will highlight the most important implications of stakeholder involvement in the examples presented, and suggest ways that other developers can use stakeholders to address equity in their own guidelines.