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New developments

SIGN guidelines are developed using an explicit methodology based on three core principles:

  • Development is carried out by multidisciplinary, nationally representative groups
  • A systematic review is conducted to identify and critically appraise the evidence
  • Recommendations are explicitly linked to the supporting evidence.

These principles have remained constant since SIGN was first established. Although these core principles remain unchanged, the detail of how they are reflected in practice has developed over the years. Major changes to our methodology are described below.

Rapid guideline methodology

While full guidelines remain SIGN's default approach to clinical guideline development, rapid guidelines may be necessary to provide important evidence-based guidance in times of urgency and emergency. Developing a rapid guideline requires balancing time, rigour and resources and may mean shortening, omitting or accelerating the processes and methods used for developing full guidelines and it must be recognised that this may lead to a less robust final guideline. Alternatively, for some topics, ensuring that the guideline is of higher quality may be more important and under these circumstances it will be necessary to allocate more resources, for example more group members, to development.

The methods used by SIGN for full guideline development are set out in SIGN 50, while the principles of rapid guideline development are contained in a manual first published in April 2021. This is a ‘living’ publication, continually revised to reflect future developments in rapid guideline methodology. For this reason the definitive version of this manual is always available on this page of the SIGN website. The current version is 1.0 (April 2021).

Comments on either content or presentation of this document are welcome and should be sent to the SIGN Executive, email: sign@sign.ac.uk

GRADE

In 2009, SIGN took the decision to implement the GRADE approach within its guideline development methodology. You can see a statement of how SIGN implemented the principles of the GRADE process.

In 2020 SIGN Council agreed that SIGN will adopt GRADE to address intervention questions in guidelines (subject to skills and resources being in place) and extend to other types of questions as the process develops. As part of the changes related to GRADE, SIGN decided, as of 2013, not to continue with the ABCD grading of recommendations that had been in use since 2001. Reasons for this decision are set out in a separate policy document.

Patient and public involvement

A number of methods are in place to capture patient and public involvement in guideline development. To demonstrate our commitment to developing person centred guidelines, we are piloting new approaches for identifying and presenting the views of people with lived experience in guidelines. With an increased emphasis on shared decision making, we have reviewed sections of the guideline template. This includes highlighting the perspectives of people with lived experience in guidelines and incorporation of information points throughout guidelines, to support informed discussion with patients, carers and families. This pilot includes incorporation of lived experiences from published literature and from engagement work with patient organisations.