Up-to-dateness of German patient versions of clinical practice guidelines and potential influencing factors: A mixed-methods study

Abstract

Introduction

Clinical practice guidelines (CPGs) provide recommendations and are a fundamental part of clinical practice. Many guideline organisations also produce patient versions of CPGs (PVGs). To explore the up-to-dateness of German PVGs, potential methodological influence factors and experts' perspectives, we applied a convergent mixed-methods design.

Methods

First, a literature search to identify PVGs was performed between October 2022 and January 2023. We searched the websites of German guideline organisations, Google and the reference lists of included PVGs. We screened the title, downloaded the documents if relevant and retrieved the underlying CPGs and methods reports of CPGs. We aggregated the literature search dates of CPGs and calculated the time between the CPG literature search and PVG publication. Second, interviews with experts in the PVG development were conducted and analysed using qualitative content analysis (Mayring) with MAXQDA.

Results

49 PVGs were included and analysed. A median of 36 months elapsed between the literature search of CPGs and the publication of PVGs. A median of 25 months passed between the literature search and publication of CPGs, and a median of 7.5 months elapsed between the CPG and PVG publication. Six interviews were conducted and interviewees mostly perceived PVGs as up-to-date. However, they identified exceptions in the up-to-dateness depending on the topic or thematic chapters of PVGs. Interviewees mentioned different influencing factors such as the scientific progress and the editorial process of PVGs.

Discussion

Our findings underline potential issues with the up-to-dateness of PVGs. In the context of a fast-moving evidence basis, it seems doubtful whether PVGs actually reflect the current state of knowledge, especially in fields with high research activity. However, some factors may not be modifiable because they essentially contribute to the quality assurance of PVGs. Further research is desirable to investigate possible measures to improve the up-to-dateness of PVGs.