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Implement Sci. 2016 Jul 15;11:93. doi: 10.1186/s13012-016-0462-y.

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels.

Author information

1
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
2
Department of Internal Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
3
Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Santiago, Chile.
4
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
5
Department of Medicine/Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri, USA.
6
Basque Office for Health Technology Assessment-OSTEBA-Directorate for Health Research and Innovation, Ministry for Health Basque Government, Vitoria-Gasteiz, Spain.
7
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogot√°, Colombia.
8
Institute for Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil.
9
Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
10
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain.
11
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. schuneh@mcmaster.ca.
12
Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. schuneh@mcmaster.ca.

Abstract

BACKGROUND:

Judgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report guideline developers' judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels.

METHODS:

Following the guideline panel meetings, we asked methodologists participating in the panel to provide feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback collected from the rest of the panel. Two investigators independently summarized the responses and jointly interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results and provide further input to improve the structure of the EtDs iteratively.

RESULTS:

The EtD framework was well received, and the comments were generally positive. Methodologists felt that in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in an explicit and transparent way. However, some sections (e.g., "values and preferences" and "balance between benefits and harms") required further development and clarification that were considered in the current version of the EtD framework.

CONCLUSIONS:

The use of an EtD framework in guideline development offers a structured and explicit way to record and report the judgments and discussion of guideline panels during the formulation of recommendations. In addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in research.

KEYWORDS:

Clinical practice guidelines; Evidence to decisions framework; GRADE; GRADEpro; Recommendations

PMID:
27417219
PMCID:
PMC4946225
DOI:
10.1186/s13012-016-0462-y
[Indexed for MEDLINE]
Free PMC Article

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