Three living systematic reviews to inform living guideline recommendations in Germany: lessons learned
2Cochrane Germany, Cochrane Germany Foundation, Freiburg AND Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
3Immunization Unit, Robert Koch Institute, Berlin, Germany
4Agency for Quality in Medicine, Germany
5Association of the Scientific Medical Societies in Germany - Institute for Medical knowledge Management, Germany
Background:
Living systematic reviews (LSRs) are increasingly used to inform decision-makers and guideline developers to achieve the best available care for patients. However, conducting and updating LSRs to support decision-making remains a challenge.
Objectives:
To discuss challenges faced in three LSRs, which were used to inform living guideline recommendations in Germany.
Methods:
In collaboration between systematic reviewers and guideline developers, recommendations from three guidelines with quickly evolving evidence were prioritized. For the prioritization process, a preliminary set of criteria was developed. Over a period of 9-12 months, LSRs were conducted and updated every 3 months. The LSRs assessed the effectiveness and safety of a) COVID-19 vaccines in children, b) E-cigarettes for smoking cessation in people with chronic obstructive pulmonary disease (COPD), and c) sacubitril/valsartan and sodium-glucose co-transporter type 2 in heart failure. Results of each LSR were presented to the respective guideline groups that assessed the need for modifying the recommendations. We describe challenges based on the experience of systematic reviewers and guideline developers that were additionally assessed within qualitative interviews.
Results:
During the conduct of LSRs to inform guideline recommendations, we experienced challenges regarding 1.) the prioritization of the guideline recommendations to be updated, which had to match to the needs of the guideline developers and resources of the systematic reviewers, 2.) the harmonisation of LSR and guideline processes, including the coordination of meetings and timely presentation of new evidence to guideline developers, and 3.) methodological challenges such as the inclusion of various study designs, adaption to epidemiological developments (e.g. COVID-19 variants), and changes of the inclusion criteria for each version of the LSR.
Conclusions:
LSRs that inform guideline recommendations require a sensitive interplay between guideline developers and systematic reviewers. Systematic reviewers and guideline developers are encouraged to discuss possible challenges in the protocol stage and throughout the whole process of the LSR.