How can clinical guidelines be designed in such a way that they enable (contextually) equitable and inclusive healthcare – and at the same time promote research and innovation in a targeted manner? Professor Dr. Sabine Oertelt-Prigione, head of the Sex- and Gender-sensitive Medicine working group, and her colleagues discuss these questions in the Perspective article Designing clinical practice guidelines for equitable, inclusive, and contextualised care. The article is part of the current special edition of the British Medical Journal (BMJ) on “Innovations in Womens Health”. Nine international authors were invited to publish their innovative approaches to women’s health in a global context in the issue, including the Bielefeld research team from the Medical School OWL.
The article focuses on the role of clinical practice guidelines (CPGs) as a strategic instrument in the interplay between care, research and innovation. “CPGs not only set clinical standards – they can also actively contribute to identifying gaps in care and influence research priorities,” says Sabine Oertelt-Prigione. “However, the prerequisite for this is consistent gender- and context-sensitive and methodologically standardised development.
© Bielefeld University/Mike-Dennis Müller
Data analysis reveals major gaps
The empirical basis is an analysis of 325 European guidelines from ten areas of expertise (2012-2022), with over 14,000 recommendations. Although 74% of the guidelines contained sex- or gender-related terms, only 4.7% of the recommendations actually addressed these aspects – mostly in the context of reproduction, gynaecology or urology. Recommendations on gender-specific issues beyond classic “women’s issues” remained the exception. This is particularly evident in cardiology: despite their high relevance, only 1.6% of the recommendations deal with cross-gender aspects. Another finding: the majority of guideline committees were male-dominated – regardless of the content. “Studies show that female researchers are more inclined to include gender aspects,” says Oertelt-Prigione. “A more diverse composition of expert committees is therefore crucial for more inclusive recommendations.” The research team is therefore calling for a structural reorientation of guideline development: target groups, social contexts and care capacities must be taken into account from the outset in order to enable guidelines that can also be applied outside of highly developed systems.
Recommendations for more inclusive guideline development
In the article, the research team therefore proposes specific methodological approaches that can support the development of guidelines in order to make them more inclusive. These include the use of the PIPOH implementation framework, which systematically records the target group, intervention, professional group, expected outcomes and care context. The authors also recommend the involvement of stakeholders with practical experience – including those from lower-income countries – and the use of digital tools for evidence-based decision-making. The prerequisite here is an ethically sound and transparent approach to AI. Feedback loops with local users could also be digitalised and continuously developed as “living guidelines”.
Finally, the team advocates the establishment of an overarching, independent institution that coordinates international standards, monitors implementation and archives guidelines centrally. This could increase transparency and traceability – even beyond Europe. “CPGs have enormous potential beyond clinical care,” says Sabine Oertelt-Prigione. “They can help to make structural inequalities in research and care visible and thus contribute to fairer healthcare worldwide.”
Further information: Homepage of the AG Sex- and Gender-sensitive Medicine
Click here or the full perspective article Designing clinical practice guidelines for equitable, inclusive, and contextualised care in the Special Edition “Innovation ins Womens Health” of the British Medical Journal.
