NICE process and methods

7 Review questions

At the start good practice guidance (GPG) development, the key areas for inclusion identified in the scope are translated into review questions. The review questions must be clear, focused and closely define the boundaries of the topic. They are important both as the starting point for the systematic literature review and as a guide for the development of recommendations by the Guidance Development Group (GDG). The development of the review questions starts after scoping and the search results should be available for the GDG1 to review.

7.1 Number of review questions

The exact number of review questions for the GPG depends on the topic and the breadth of the scope (see section 4). However, the number of review questions must be manageable to enable the GDG and the NICE project team to complete guidance development within the agreed timescale. For most GPG topics, 8–12 review questions is a reasonable number. However, review questions vary considerably in the number of relevant studies and the complexity of the question and analyses, and the numbers of questions given here are only a guide. For example, a single review question might involve a complex analysis of a large volume of evidence. At the other extreme, a question might address the effects of a single, simple process and have little relevant evidence.

7.2 Developing review questions from the scope

Review questions are developed by the NICE project team after approval of the scope of the GPG. The review questions should address all areas covered in the scope, and should not introduce new aspects not specified in the scope. They contain more detail than, and should be seen as building on, the key areas identified in the scope.

7.3 Formulating and structuring review questions

A good review question is clear and focused. The exact structure of the review question depends on what is being asked, but it is likely to fall into 1 of 5 main areas:

  • Legislation and regulation

  • Systems and processes

  • Governance

  • Patient safety

  • Training and competencies.

The review questions are based on thematic analyses of the issues raised by the scoping process and are developed using a broad PICO (population, intervention, comparator and outcomes) framework (see section 4.4.1).

Each review question takes into account the various confounding factors that may influence the outcomes and effectiveness of a system or process and specifies the healthcare setting for the question if necessary. To facilitate this process, outcomes and other key criteria considered to be important are listed.

7.4 Using the review questions to inform the search strategy

Once the review question has been developed, this is signed off by the NICE project lead. After sign off, the NICE project team uses the review questions to identify search terms that inform the literature search strategy. Search terms are provided to NICE's guidance information services[2] on a literature search request template (see appendix A). The information service providers then develop the search strategy. Search results, including the search strategy are returned to the NICE project team (see section 8.4). The review questions and search results are reviewed, discussed and agreed by all GDG members at the first GDG meeting. The different perspectives among GDG members help to ensure that the right review questions are identified. On occasion, the questions may need refining once the evidence has been searched; such changes are documented.

[2] Where NICE guidance information services are referred to, an externally commissioned information service may be used to provide support in this area in some cases.