Inclusion of sex and gender in clinical practice guidelines: an umbrella review.

Abstract

Clinical practice guidelines (CPGs) are key to standardised, evidence-based and equitable healthcare, and the inclusion of sex and gender considerations in CPGs is increasingly recognised as essential for quality care and health equity. This umbrella review synthesised evidence from reviews examining the extent and quality of sex and gender considerations in CPGs and identified barriers and best practice strategies to support their inclusion. Literature searches were conducted across eight databases, identifying systematic reviews and other reviews published between 2000 and 2025 that focused on sex and gender considerations in CPGs. Data extraction and quality appraisal followed Joanna Briggs Institute guidelines. After descriptively summarising the reviews, narrative synthesis was used to summarise how sex and gender considerations were integrated across the included reviews, identifying common issues and recommendations for improving their incorporation into CPGs. Analysis of the seven included reviews (appraising a total of 784 CPGs) found that despite mention of sex or gender in 69% of CPGs, only 15% incorporated these factors into diagnostic or management recommendations, reflecting inconsistent, conceptually unclear and often superficial application. Major barriers included under-representation of women, limited sex and gender expertise on guideline committees, incomplete translation of sex-specific and gender-specific evidence into recommendations, inconsistent terminology and methodological limitations in guideline development. To address these gaps, the included reviews identified several strategies that could be implemented before, during and after the guideline development process. Sex and gender inclusion in CPGs remains inconsistent and superficial, with significant implications for health equity. Addressing this requires strengthening sex-informed and gender-informed evidence, ensuring diverse and expert representation in guideline development and adopting systematic approaches that translate evidence into equitable, population-responsive recommendations.