Representations of clinical practice guidelines and health equity in healthcare literature: An integrative review

• Published in: Journal of nursing scholarship 2023-03, Vol.55 (2), p.506-520
• Main Authors: McMillan Boyles, Christina, Spoel, Philippa, Montgomery, Phyllis, Nonoyama, Mika, Montgomery, Kyle
• Format: Article
• Language: English
• Subjects: Appreciation; Checklist; Clinical decision making; Clinical medicine; Clinical practice guidelines; Computerization; Concept formation; Content analysis; Decision makers; Decision making; Delivery of Health Care; Disadvantaged; English language; equity; evidence‐based practice; Health care; Health disparities; Health Equity; health of specific populations; health policy; Health Resources; Health services; Human resources; Humans; Implementation; integrative review; Literature reviews; Medical personnel; policy development/policy making; Policy making; quality of care; Resource allocation; Uptake
• ISSN: 1527-6546; 1547-5069
• DOI: 10.1111/jnu.12847

Aim This paper reports an integrative review of international health literature that discusses health equity in relation to clinical practice guidelines (CPGs). Background Healthcare professionals (HCPs), policy makers, and decision makers rely on sound empirical evidence to make fiscally responsible and appropriate decisions about the allocation of health resources and health service delivery. CPGs provide statements and recommendations that aim to standardize care with an implicit goal of achieving equity of care among diverse populations. Developers of CPGs must be careful not to exacerbate inequity when making recommendations. As such, it is important to determine how equity is discussed within the context of CPGs. Design This integrative review was conducted according to integrative review methods as outlined by Whittemore and Knafl (2005), and Toronto and Remington (2020). These authors outlined a systematic process for the identification of relevant literature across health disciplines to examine the state of knowledge pertaining to a phenomenon such as health equity. Search Methods The computerized databases PubMed, CINAHL, Cochrane, Embase, Medline, and Web of Science were searched using a combination of keywords. Search parameters included international peer‐reviewed published, full‐text, English language articles, editorials, and reports over the last decade (January 2011 to February 2022). A reference search of included articles was conducted to identify any additional articles. Dissertations and theses were not included. Search Outcome A total of 139 peer‐reviewed English language articles were identified. Results The findings of this review revealed five main ways in which health equity is in context of CPGs including if they target or exacerbate inequity among disadvantaged populations, equity and CPG development, implementation, and evaluation, and checklists and tools to assist developers and users of CPG to consider equity. Although critical appraisal tools exist to assist users of CPGs assess and to evaluate how well CPGs address issues of equity, the definition of equity and how CPG development panels should incorporate and articulate it remains unclear and haphazard. As such, recommendations intended to be implemented by HCPs to optimize health equity remains diverse and unclear. Conclusion The way equity is discussed within the reviewed health literature has implications for their uptake by and utility for HCPs. The ability of HCPs to