Attention to sex-related factors in the development of clinical practice guidelines.
BACKGROUND
Clinical practice guidelines describe optimal strategies for disease prevention, diagnosis, or treatment. Increasing evidence indicates that sex-related factors may have an impact on these strategies. We examined the way in which two Dutch guideline organizations address evidence on sex factors in their guideline development methodologies. We then determined whether attention to these factors could be improved and, if so, how this could be done.


METHODS
We selected seven recent guidelines on four conditions: hypertension, depression, osteoporosis, and rheumatoid arthritis. We studied information obtained from interviews with members of the guideline committees and analyzed the content of the guideline documents themselves. Our findings were discussed at an expert meeting.


RESULTS
We found that all the guideline committees concerned applied an internationally accepted framework for guideline development. The proportion of male members ranged from 67% to 100%. None of the guidelines included a question (or subquestion) focusing on sex-related factors. In the literature searches no sex-specific search terms were used. Critical appraisals did not include any systematic focus on sex-related factors or effects. The number of sex-specific recommendations (relative to the total number of recommendations) ranged from 0 of 82 and 0 of 148 in the guidelines on depression to 16 of 84 in one of the guidelines on osteoporosis.


CONCLUSIONS
We found that when developing guidelines, none of the committees systematically focused on sex-related factors that might be relevant to the way in which evidence is identified, appraised, or described. A number of recommendations were made with the aim to facilitate greater attention to sex-related factors in the current methods of guideline development.
Keuken
D G
DG
Department of General Practice, Academic Medical Center-University of Amsterdam, Division of Clinical Methods and Public Health, Amsterdam, The Netherlands. d.g.keuken@amc.uva.nl
Haafkens
J A
JA
Moerman
C J
CJ
Klazinga
N S
NS
ter Riet
G
G
D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000628:therapy; D003863:Depression / Q000175:diagnosis / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy; D008297:Male; D009426:Netherlands; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012107:Research Design / Q000592:standards*; D012737:Sex Factors