Best Practice Methods for Living Evidence Synthesis in Health Care: An International Modified Delphi Survey
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Background
Living evidence syntheses (LES) represent continual updates for an important topic for decision-making where there is uncertainty in the evidence. Whereas best practices for traditional evidence syntheses in health care are well established, they are not for LES. This study aimed to establish globally relevant, agreed-upon standards for considering, conducting, publishing, and implementing LES in health care.
Methods
A modified Delphi consensus process was conducted. Potential participants were identified through a prior survey, workshop, and targeted outreach based on expertise and representation across global organizations producing or supporting LES. Three modified Delphi rounds were administered using JISC Online Surveys between January and April 2025. Participants rated 23 statements on a five-point Likert scale. Consensus was defined as ≥80% agreement (‘agree’ or ‘strongly agree’) with ≥85% panel response rate required per round. Qualitative feedback guided iterative statement revision.
Draft statements were informed by an overview of living systematic reviews, a living evidence survey plus workshop activity, and an ongoing living critical interpretive synthesis of LES. Statements expanded upon the living methodology reporting guidance published by the PRISMA-LSR group to include other considerations for LES.
Results
The Delphi panel comprised 29 experts from around the world, with 27 (93%) completing round 1, 26 (90%) round 2, and 27 (93%) completing round 3; 19 of 23 statements achieved consensus. Statements described conduct (n=12), including set up and maintenance of living mode as well as funding and resources; reporting (n=2); publishing (n=4); and implementation/appraisal (n=1).
Final statements included ways to enable the living mode, such as version history; authoring tools; collaboration; unit of update; transparency; communication; publication considerations; and digital and technological considerations.
Conclusions
This study presents the first established consensus for best practices in considering, conducting, publishing, and implementing LES in health care. These LES standards can help align global processes, improve transparency, and promote sustainability. But there is still more to be done to accomplish these objectives, requiring that groups collaborate to embrace digital tools, adopt interoperability standards, and create effective appraisal tools.
