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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.

Using other organisations' guidelines

Developing evidence-based clinical practice guidelines is a time and resource-intensive process. It also requires considerable specialist input. Many good-quality guidelines are produced by other agencies. To avoid duplication of effort and make best use of our resources, we now consider guidelines produced elsewhere at the first step of our evidence review.

Our guideline adaptation process was informed by the WHO handbook for guideline contextualisation and the ADAPTE Collaboration methodology.

Guidelines must be shown to have followed an acceptable methodology before they can be considered for use by SIGN guideline developers. Identified guidelines are appraised using the AGREE II tool to agreed thresholds, appropriate for the topic under consideration.

A consensus voting process, with a wide group of stakeholders, indicated whether:

  • the recommendation, as written, is acceptable and feasible for adoption by NHSScotland
  • the recommendation is acceptable and feasible for adoption, with adaptations to the Scottish context (without changing the scope or intention of the original recommendation)
  • the recommendation acceptable and feasible for the Scottish context by adapting the scope or intention of the original recommendation, e.g. to include new local evidence, to extrapolate to a different population, to include locally available interventions
  • the recommendation is not acceptable and feasible for NHSScotland.

More information can be found in SIGN 50.

Patient and public involvement

Our new approach emphasises person-centred care by focusing on the needs and priorities of patients and the public using ‘what matters to you?’ discussions throughout the development of guidelines. We are refreshing our Patient and Public Involvement Network (PPI network) and working in partnership with members, to ensure that guidelines are both relevant and reflective of real-world experiences and needs.

We are recruiting more condition-specific third sector organisations (of all sizes), focusing on those who are willing to engage with us regularly and at short notice.

The PPI Network will have greater influence over decisions, ensuring that patient perspectives are better integrated into the overall development process. ‘What matters to you?’ statements summarising preferences of people with lived experience and third sector organisations representing them will be included in the guideline.

More information can be found in SIGN 50.

Rapid guideline methodology