Guidance reconciliation and practice question prioritization for a World Health Organization's Ebola and Marburg Disease guideline

Objective: To describe the processes of reconciling overlapping guidance and prioritizing practice questions for a World Health Organization (WHO) guideline on Infection Prevention and Control (IPC) for Ebola and Marburg disease.

Methods: This work involved the reconciliation of guidance, the generation of potential practice questions and the prioritization of those questions. Contributors included the WHO secretariat, the WHO steering group, the guideline methodologists, and the guideline development group (GDG). We extracted all actionable statements that fit the scope of the planned guidelines from existing WHO documents and classified them according to the type of the actionable statement they aligned with. We then constructed the practice questions, which were subsequently prioritized by the GDG. A scoring tool consisting of five prioritization criteria was developed: (1) uncertainty or controversy about best practice, (2) unsatisfactory existing guidance, (3) potential for changing existing guidance, (4) impact of intervention on health outcomes, and (5) feasibility of intervention implementation.

Results: Our process identified 18 practice questions suitable for development as formal recommendations that needed to be prioritized. The average total priority score was 20.49 (standard deviation = 1.27). We found high correlation between three prioritization criteria: 'uncertainty or controversy about best practice', 'unsatisfactory existing guidance', and 'potential for changing existing guidance'.

Conclusion: Our approach was feasible and may be useful for guideline projects where overlapping guidance exist and need to be updated.