Correspondence on “Needs Assessment for Updating Institute of Medicine Standards for Trustworthy Clinical Practice Guidelines”

Christopher Wolfkiel and colleagues have published a valuable needs assessment for updating the IOM standards 1. This study is highly necessary and leading. However, we would like to offer several comments on the study's conclusions and provide suggestions regarding key areas for updating. For conflict of interest (COI) management, Xun et al. 2 have developed a relatively comprehensive framework, which is included in the extended RIGHT (Reporting Items for practice Guidelines in HealThcare) checklist of COI&F. To better incorporate and report stakeholder involvement in guideline development process, Xuan et al. 3 are currently developing the RIGHT-MUSE checklist, an extension of RIGHT dedicated to stakeholder engagement. On the topic of guideline certification, as raised in the article, Nan et al. 4 developed the STAR tool to evaluate the scientificity, transparency, and applicability of guidelines. Since 2023, the STAR Working Group has been conducting annual rankings of Chinese clinical guidelines, identifying trustworthy guidelines and supporting certification efforts. Most of the above tools have attracted attention in the relevant fields and may serve as practical references for updating the IOM standards. Therefore, we strongly recommend the update of IOM standards should emphasize the integration and promotion of such mature, widely accepted tools. Additionally, we think the urgency of the update may be overstated in the article's conclusions. While the general survey shows most respondents agree the standards "should be subject to review," this indicates a need, but not necessarily urgency. Similarly, the domain- and item-level analysis reveals that "Hold now" was the most selected option, suggesting that many elements are still viewed as currently appropriate. To enhance clarity and reduce potential reader confusion, we suggest defining a threshold for interpreting urgency. For example, if fewer than 80% of respondents select "Hold now," an item could be considered for update. Such an approach would help align conclusions more closely with the presented data. We hope these comments will be helpful in guiding future updates of the IOM standards. Funded by Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China. The authors declare no conflicts of interest. The authors have nothing to report.