Development of living evidence-informed guidelines, part 1: Framework for the conduct of living systematic reviews and guidelines

Background: Living guidelines integrate continuous and dynamic updates of systematic reviews to support timely, evidence-informed recommendations. This approach addresses the limitations of static guidelines in rapidly evolving clinical and public health contexts. Living evidence-informed guidelines enable clinicians to implement the most trustworthy and up-to-date research for the benefit of their patients. Types of Studies Reviewed: The living framework draws on methodological literature, case studies from international living guideline initiatives, and experiential reports. Sources include published guidance on living systematic reviews; Grading of Recommendations Assessment, Development and Evaluation methodology; and real-world applications from organizations like the National Institute for Health and Care Excellence and the Australian Living Evidence Collaboration's COVID-19 Taskforce, illustrating operational strategies across planning, production, dissemination, and updating processes. Results: The framework outlines the following 5 core domains for developing living guidelines: planning, production, reporting, dissemination, and implementation. Key components include topic prioritization, guideline panel composition, continuous evidence monitoring, and decision-making processes guided by the Grading of Recommendations Assessment, Development and Evaluation Evidence-to-Decision framework. Artificial intelligence facilitates literature monitoring and data extraction. Criteria are proposed for transitioning between living and standard recommendation modes. Transparency in reporting updates and structured external review enhance living guideline trustworthiness. Digital dissemination platforms support timely access and interest-holder engagement. Conclusions and Practical Implications: This framework provides practical guidance for organizations developing living guidelines, offering strategies to enhance responsiveness, methodological rigor, and user engagement in rapidly evolving clinical and policy environments. Living evidence-informed guidelines developed following these methods provide updated and reliable evidence for clinicians, patients, and interest-holders, bringing transparency and accessibility of the history of all formulated recommendations.