Methods for living guidelines: learnings from developing and disseminating implementable living guidelines in the Australian context

BACKGROUND: Living clinical guidelines provide decision-makers with up-to-date, reliable guidance to inform clinical and policy decisions. As the production of living guidelines increases internationally, it is important that they are effectively disseminated and implemented. However, there is limited guidance about how to achieve this goal. This commentary synthesizes practical experiences from guideline developers within the Australian Living Evidence Collaboration, structured around five phases of a typical living guideline lifecycle: scoping, development, dissemination, implementation, and evaluation. DISCUSSION: Living guideline production, dissemination, and implementation require strategies to ensure ongoing relevance, transparency, and sustained stakeholder engagement. Suggestions for effective scoping and development of living guidelines and disseminating and implementing them include the following: (1) developing continually relevant guidelines, (2) transparency and sustained engagement to aid guideline implementability, (3) setting expectations about communication of updates and continually refining dissemination approaches, (4) using data to improve implementation strategies, and (5) using multifaceted evaluation approaches to refine and improve future iterations. Challenges specific to living guidelines include sustaining stakeholder engagement over time, maintaining transparency in dissemination without information overload, designing implementation strategies that are responsive to evolving guidelines and changes to practice and policy, and developing effective evaluation strategies to demonstrate the evolving impact of clinical guidelines. Strategies for effective development, dissemination, and implementation of living guidelines build on principles that apply to conventional guidelines. Continued efforts to sustain stakeholder engagement, ensure transparency of updates, and refine implementation strategies are likely to optimize access to and adoption of living guidelines.