Integrating Environmental Sustainability Into Evidence-Based Clinical Guidelines: Methodological Guidance Report.

Introduction: The global healthcare sector significantly contributes to climate change and other environmental impacts. Despite this, environmental sustainability considerations are often missing from evidence-based clinical guidelines. To address this gap, we developed a methodological guidance report focused on integrating environmental sustainability into clinical guidelines. Methods: An interdisciplinary expert panel systematically developed this methodological guidance report. Data collection involved expert panel meetings and consultations with stakeholders, based on the development of a sustainability guideline focused on reducing the environmental impact of the operating room (OR). The process included an initial inventory and prioritisation phase, guideline development following the GRADE approach, and finalisation and publication. Results: The generated insights offer a standardised and readily applicable guidance report for integrating environmental sustainability into clinical guidelines across medical disciplines. This allows guideline developers to implement sustainability considerations in clinical guidelines. Environmental sustainability should be addressed at the start of guideline development, involving interdisciplinary experts. Approaches include integrating environmental outcomes into the PICO framework or adding a search question focused on the environmental impact of interventions. Furthermore, environmental sustainability should be integrated in the Evidence-to-Decision framework. If LCAs are included, both the critical appraisal for study quality of LCAs and the GRADE approach for quality of the evidence are recommended. Interpretation: This methodological guidance report facilitates a stepwise approach of integrating environmental sustainability into clinical practice through evidence-based guideline development. While further evaluation and implementation in clinical practice is needed, the framework supports more sustainable clinical decision-making and contributes to promoting planetary health.