Background We were commissioned to partially update a clinical guideline. The remit was to develop new service delivery recommendations to support implementation of the guideline whilst leaving the existing clinical recommendations unchanged.
Objectives To describe the approach taken in partially updating a guideline to improve its implementation. To discuss the problems encountered and possible solutions.
Methods At the time, there was limited guidance on conducting service delivery evidence reviews. A methodology was developed and agreed by the developers, the NICE Methodology Team and the GDG which aimed to ensure the process was as robust, reproducible and transparent as possible.
Results Limited evidence was identified using the agreed methodology. This prevented identification of successful service delivery models. It also became apparent that that some of the implementation issues were embedded in the original guideline recommendations, and these could not be changed.
Discussion The methodology used could not adequately address the implementation issues, as it was not possible to amend any of the problematic recommendations, or describe a method of service delivery that was clinically and cost effective. Agreement could not be reached on how to progress with developing the recommendations, and so a decision was made to cease publication of the service delivery recommendations.
Implications for Guideline Developers/Users Partial updates are more challenging for guidelines requiring implementation support and should: 1) Go through a process to assess the issues before deciding how guideline should be updated. Or 2) Come with a remit to enable the developers to amend the recommendations for which implementation support is sought.
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