Including sex and gender in clinical practice guidelines to increase health equity and improve patient management
Various population characteristics need to be considered in scientific research papers to improve the quality of evidence and increase its implementation across different cohorts. This process should reduce research gaps across various strata of the general population, as well as improve health outcomes and standardise the management of patients. One of the key characteristics that need to be considered from both biological and societal perspectives are the determinants that depend on sex and gender differences.
Clinical practice guidelines (documents that are used by a wide range of health professionals) may play a key role in resolving sex and gender differences by incorporating these aspects into evidence synthesis and practice recommendations. As such, clinical practice guidelines may serve as a support mechanism to increase both identification of research gaps and implementation of evidence-based-medicine recommendations by considering various sex and gender health determinants.
For efficient inclusion of sex and gender aspects, these should be considered during the guideline development process; for example, in planning subgroup analyses during evidence synthesis and in reporting the evidence and recommendations. To fulfil the latter aspect in guidelines, as well as in original research, authors need to be clear and consistent in the definition of the terms ‘sex’ and ‘gender’: the first being a biological determinant and second a social construct. As documents that are supposed to improve clinical practice, guidelines must consider both aspects to better reflect real-life conditions and facilitate the implementation of their recommendations. To enable efficient analysis of evidence based on various sex and gender aspects, generalisations should be avoided, and guideline developers should clearly describe how these determinants may influence health outcomes.
Besides being determinants of brain health, sex and gender influence the diagnosis and management of several neurological disorders. Preclinical evidence has also shown that sex has a major impact on pharmacodynamic and side effects of drugs. In clinical trials, however, these determinants have only recently been considered. Moreover, it has been shown that gender influences various outcomes in patient management, as well as caregiver burden, which is an important consideration in disabling neurological diseases. Therefore, sex and gender should be carefully considered when recommending diagnosis and management of neurological disorders.
One of the main goals of the European Academy of Neurology (EAN) is to improve the management of neurological diseases across Europe and standardise patient care across countries. However, as the importance of sex and gender guidelines has gained prominence only recently, it is not clear to what extent they are included in current EAN clinical practice guidelines. To investigate this, the EAN Diversity Task Force and EAN Guideline Production Group plan to clearly identify the current guideline gaps where the inclusion of sex and gender is needed, taking into consideration both evidence analysis and reporting in recent EAN guidelines. This project will provide insight into the potential of mechanisms that need to be implemented to increase sex and gender inclusion in future EAN guidelines.
Links to additional resources:
Sex and gender considerations in reporting guidelines for health research: a systematic review | Biology of Sex Differences | Full Text (biomedcentral.com)
Authors
Katina Aleksovska1, Vanessa Carvalho2 and Isabella Colonna3
1. European Academy of Neurology, Vienna, Austria
2. Hospital de Santa Maria: Lisboa, Lisboa, Portugal
3. Francesco Ferrari Hospital, Casarano, Lecce, Italy
Disclaimer
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