Appendix N: Multi-criteria decision framework for deciding whether to develop or update recommendations and which methods to use

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Developing NICE guidelines: the manual – appendices A to O

The following frameworks can be used to decide whether to develop or update recommendations and which methods to use. They should be used in conjunction with the appendix on interim principles for methods and processes for supporting digital living guideline recommendations. This appendix is a living document that is reviewed on a regular basis.

Guideline details

Guideline number	For example, NGXXX
Topic area	-
Date signal from living monitoring received	Day Month Year
Currently recommended	Summary of recommendations in this area in the guideline or suite
Signals from monitoring	Brief summary of the signal sources, such as evidence and other intelligence

Multi-criteria decision framework: proportionate approach to planning

Complexity and system priority	Is this a complex topic area? Is this a system priority? (For example, does it reduce waiting lists or current variation in practice?)
Methods of updating	Is this topic area part of 'living' systematic review? Are there good quality external evidence reviews? (For example, Cochrane) Does this need full systematic review and evidence synthesis? Does current evidence (old and new) give certainty? Are there good-quality external guideline recommendations? Could we collaborate with an external organisation? Update with or without full systematic review?
Committee input	Do we need committee's input? Committee's input: virtual or in-person meeting, email only or other efficient approach?
External validation	Full consultation or targeted engagement? Or no consultation? Give rationale.
Currency and overlap	When was the topic area or review question being considered last reviewed or updated? Does the topic area overlap with other suites, independent guidelines, or foundational guidelines? Or other NICE guidance?
Other contextual intelligence	Should other factors or intelligence (not covered by the above) be considered? This could include ad hoc conversations with key people, or intelligence from enquiries, or Implementation and Insight Programme feedback.

Final decision

Update with	Full systematic review and evidence synthesis No systematic review External systematic review Targeted review Living systematic review Collaboration with external developer Contextualised content from external developer Cross referral to external developer Stand down recommendations with no further action Note: there could be combinations of the above
Health economic model	–
Committee or topic expert input	Input through virtual or in-person meetings, or by email No need for committee or topic expert input
Validation	Public consultation Targeted engagement No consultation Note: a mix of validation options may be used, but will need to be justified in each case because this may be resource intensive

This page was last updated: 23 October 2025