"Living guideline recommendations" - more important than ever?! Successes and challenges of "living guidelines": A systematic evaluation

Monika Nothacker; Jordana Dreger; Ina Kopp; Susanne Blödt

doi:10.1016/j.zefq.2025.05.003

"Living guideline recommendations" - more important than ever?! Successes and challenges of "living guidelines": A systematic evaluation

Z Evid Fortbild Qual Gesundhwes. 2025 Jun 20:S1865-9217(25)00144-8. doi: 10.1016/j.zefq.2025.05.003. Online ahead of print.

Authors

Monika Nothacker¹, Jordana Dreger², Ina Kopp², Susanne Blödt²

Affiliations

¹ Association of the Scientific Medical Societies in Germany, Institute for Medical Knowledge Management (AWMF-IMWi), Philipps-Universität, Marburg, Germany. Electronic address: nothacker@awmf.org.
² Association of the Scientific Medical Societies in Germany, Institute for Medical Knowledge Management (AWMF-IMWi), Philipps-Universität, Marburg, Germany.

PMID: 40544128
DOI: 10.1016/j.zefq.2025.05.003

Abstract

Introduction: The development of high-quality guidelines is resource-intensive and time-consuming, and currency is crucial for the improvement of care. Criteria-based update procedures are recommended. Living guidelines (LGs) are intended to quickly incorporate new findings. The guidance of the Association of the Scientific Medical Societies in Germany (AWMF) require an annual review and needs-based updating. Internationally, there are different definitions; in particular, the concept of "living recommendations" based on "living systematic reviews" is recommended.

Methods: A search for LGs (March - May 2024) was carried out in the AWMF guideline registry, Medline and three international guideline databases to compare current German and international LGs based on criteria of an LG framework concept and to identifiy favorable and unfavorable implementation factors.

Results: Few current guidelines (12 German and 26 international) followed a 'Living' concept. Decisions for German LGs were mostly made per project, internationally mostly at the organisational level. Compared to international LGs, German LGs had more recommendations, with less evidence-based content, and a lower research and update frequency. Not all LGs had a transparent methodological documentation with labelling of new, amended, or confirmed recommendations. More international than German LGs are available in apps with direct access to recommendations.

Discussion: The "Living Guideline" concept is rarely implemented, and the approach continues to vary. During the COVID-19 pandemic, resources and motivation were high. Currently, organizational support in combination with a rather narrow guideline scope seem to offer the best conditions for LGs.

Conclusion: We need current and trustworthy guidelines. Actual concepts provide different opportunities. To support them, decisions should also be made at the organizational level.

Keywords: Aktualisierungsprozess; Criteria; Framework; Kriterien; Lebende Leitlinie; Living guideline; Living guideline recommendation; Rahmenkonzept; Updating.