The methodology used to develop the guideline is based on SIGN 50: a guideline developer’s handbook which adheres to the AGREE II (Appraisal of Guidelines for Research and Evaluation; https://www.agreetrust.org/) criteria.
A scoping search is conducted every 6 months and published as an evidence bulletin. Any new findings from the search results are mapped to the relevant section of the guideline. Any evidence of relevance to the equality impact assessment is also considered.
The steering group consider the new findings and discuss any new changes in practice. On an annual basis we hold a consensus vote to prioritise the next topics for update.
Updates are noted in the guideline schedule.
For each topic selected for update we conduct a search for guidelines from other organisations that could be adopted or adapted (see SIGN 50: A guideline developer’s handbook, 2025).
If the topic cannot be updated using guidelines from other organisations, in total or in part, we carry out an evidence review to identify any relevant studies.
Key questions are defined using the Patient, Intervention, Comparison, Outcome, Setting format.
An Information Scientist carries out a systematic literature review using a number of databases, including Medline, Embase and CINAHL. A Health Services Researcher selects and critically appraises the evidence using the SIGN checklists.
Subgroup members use the evidence to form recommendations. Where there are gaps in the evidence the subgroup discusses and agrees the recommendations based on their expert opinion. The following factors are taken into account when determining recommendations (known in SIGN methodology as considered judgement):
The draft guideline is published on the SIGN website for a month and widely publicised to professional and patient representative groups most likely to have an interest in the topic. Individuals or corporate, commercial, professional or societal groups can submit comments. Comments are only accepted if accompanied by a declaration of interests from the reviewer.
All feedback is compiled into a consultation report. The subgroup addresses each comment and their response is published in the consultation report.
As a final quality control check before publication, the guideline and the consultation report are reviewed by the Scottish Intercollegiate Guidelines Network (SIGN) Editorial Group. This consists of the SIGN Chair, SIGN Programme Lead, Healthcare Improvement Scotland Director of Evidence and Digital, and the Chair of the SPCG.
The Editorial Group ensures that each point raised at consultation has been addressed adequately and that any risk of bias in the guideline development process has been minimised.
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AGREE II Requirement |
How the requirement is met |
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Domain 1: Scope and purpose |
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1. The overall objective (s) of the guideline is (are) specifically described |
Described in the background section of the guideline. |
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2. The health question(s) covered by the guideline is (are) specifically described. |
We set key questions using the Patient, Intervention, Comparison, Outcome, Setting (PICOS) format. |
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3. The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described. |
Described in the background section of the guideline. |
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Domain 2: Stakeholder engagement |
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4. The guideline development group includes individuals from all relevant professional groups. |
The steering group and subgroups consist of multidisciplinary health and social care staff and public partners from across Scotland. Subgroup membership is listed in the guideline under each specific topic. |
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5. The views and preferences of the target population (patients, public, etc.) have been sought. |
Public partners are on the steering group and some subgroups. We notify voluntary organisations when consultation drafts are available for open feedback. |
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6. The target users of the guideline are clearly defined. |
Described in the background section of the guideline. |
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Domain 3: Rigour of development |
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7. Systematic methods were used to search for evidence. |
We set PICOS key questions and conduct a systematic literature search using multiple databases. |
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8. The criteria for selecting the evidence are clearly described. |
We select evidence based on the PICOS key questions. |
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9. The strengths and limitations of the body of evidence are clearly described. |
Where relevant, strengths and limitations are noted. How the topic was developed is described at the end of each piece of guidance. |
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10. The methods for formulating the recommendations are clearly described. |
When agreeing the recommendations we use informal consensus through discussion, using the following criteria:
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11. The health benefits, side effects, and risks have been considered in formulating the recommendations. |
We use the following criteria:
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12. There is an explicit link between the recommendations and the supporting evidence. |
We cite the references used for each topic. Each topic has a section describing how the guideline was developed. |
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13. The guideline has been externally reviewed by experts prior to its publication. |
Drafts of each updated topic are available for consultation. We address each comment and publish the consultation report alongside the updated topic. |
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14. A procedure for updating the guideline is provided. |
A Health Services Researcher maps the results of the scoping search to the existing guideline. On an annual basis the steering group prioritise topics for update through a consensus voting process. Their decision making is informed by new evidence and clinical knowledge of changes in practice. |
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Domain 4: Clarity of presentation |
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15. The recommendations are specific and unambiguous. |
We word the recommendations concisely and with active language. |
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16. The different options for management of the condition or health issue are clearly presented. |
We use a standard template for each topic. |
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17. Key recommendations are easily identifiable. |
We highlight key points in the text. |
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Domain 5: Applicability |
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18. The guideline describes facilitators and barriers to its application. |
Where relevant this is documented in the introduction relating to each topic. |
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19. The guideline provides advice and/or tools on how the recommendations can be put into practice. |
The format of the published guideline is designed to be useful in day to day practice. Where relevant we include links to tools or further prescribing information. |
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20. The potential resource implications of applying the recommendations have been considered. |
This is included in the considered judgement stage of the guideline development (see item 10) |
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21. The guideline presents monitoring and/or auditing criteria. |
We gather data on hits to the guideline and app downloads. |
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Domain 6: Editorial independence |
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22. The views of the funding body have not influenced the content of the guideline. |
The Scottish Government fund the project but the work is driven by the steering group and facilitated by the SIGN team within Healthcare Improvement Scotland. |
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23. Competing interests of guideline development group members have been recorded and addressed. |
All those participating in, or commenting on, the guideline must submit a declaration of interests. Competing interests are managed in line with the SIGN https://www.sign.ac.uk/assets/doi_policy.pdf. |
Scottish Palliative Care Guidelines
