Strategies in assessing the need for updating evidence-based guidelines for six clinical topics: an exploration of two search methodologies

Abstract

Background: Because of the expense of updating practice guidelines, recent attention has focused on approaches that can reliably assess any updating required. Shekelle et al. (Journal of the American Medical Association 2001, 286, 1461-7) proposed using limited literature searches with expert involvement to reduce resources used in assessing whether a guideline needs updating.

Objectives: This study compared Shekelle's method and the traditional systematic review method regarding comprehensiveness and effort.

Methods: Two research teams translated critical key questions on screening test treatments and outcomes to Medical Subjects Headings (MeSH) and search strategies. They refined Shekelle's method over three iterations, seeking greater efficiency. Using both methods independently, teams assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services (US Preventive Services Task Force). Outcomes included completeness of study identification, importance of missed studies and effort involved.

Results: The revised review approach produced fewer citations than the traditional approach and saved time, identifying fewer eligible studies than the traditional approach. None of the studies missed was rated important by the experts consulted.

Conclusions: The revised review approach provides an acceptable method for judging whether a guideline requires updating. Librarians were an integral part of the research process that streamlined the searches.