One size does not fit all: How contextual factors shape learning needs in guideline development - a multiple case study.

Abstract

Introduction: Clinical guideline development is a complex, multidisciplinary process in which panels formulate recommendations. Many panel members have limited education before participating in a panel, even if this can enhance their competencies. There is variety in guidelines and healthcare contexts for which guidelines are developed. Currently, it is unclear how contextual factors shape guideline development processes and panel members' learning needs. This study examined how contextual factors affected guideline panel members during the guideline development process and influenced their learning needs.

Methods: We conducted a qualitative multiple-case study of five Dutch multidisciplinary guideline projects supported by an educational programme. Panels were followed longitudinally from their first meeting to the final training session (March 2024-June 2025). Semi-structured interviews were conducted with eighteen panel members and ten project leads. Data were analysed using an iterative inductive-deductive reflexive thematic analysis approach, with the levels of Bronfenbrenner's social-ecological model as sensitising concepts.

Results: Three interrelated themes shaped learning needs. First, the guideline topic influenced panel composition, methodological choices, and the extent to which panels had to rely on expert judgment due to limited or low-certainty evidence. Second, participation dynamics, including individual characteristics (i.e. confidence and prior experiences), hierarchy, and psychological safety, affected engagement and whose expertise was integrated into the guideline. Third, task allocation varied substantially between projects, particularly regarding involvement in evidence appraisal and drafting recommendations, resulting in different competency requirements. Meeting formats (online versus in-person) further shaped interaction and learning. Importantly, the themes interacted; for example, topic-driven methodological demands shaped task allocation and participation, while participation dynamics influenced topic (key question) prioritisation.

Discussion: Methodological competence alone is insufficient for effective participation in guideline development. Learning needs arise from the combined influence of the guideline topic, participation dynamics, and task allocation. Educational initiatives should therefore adopt a flexible, context-sensitive, and role-specific approach.