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Multicenter Study
. 2018 Dec:104:103-112.
doi: 10.1016/j.jclinepi.2018.09.007. Epub 2018 Sep 22.

Evidence to Decision framework provides a structured "roadmap" for making GRADE guidelines recommendations

Shelly-Anne Li  1 , Paul E Alexander  2 , Tea Reljic  3 , Adam Cuker  4 , Robby Nieuwlaat  2 , Wojtek Wiercioch  2 , Gordon Guyatt  2 , Holger J Schünemann  2 , Benjamin Djulbegovic  5
Affiliations
Multicenter Study

Evidence to Decision framework provides a structured "roadmap" for making GRADE guidelines recommendations

Shelly-Anne Li et al. J Clin Epidemiol. 2018 Dec.

Abstract

Objectives: It is unclear how guidelines panelists discuss and consider factors (criteria) that are formally and not formally included in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. To describe the use of decision criteria, we explored how panelists adhered to GRADE criteria and sought to identify any emerging non-GRADE criteria when the panelists used the Evidence to Decision (EtD) framework as part of GRADE application.

Study design and setting: We used conventional and summative qualitative analyses to identify themes emerging from face-to-face, panel meeting discussions. Forty-eight members from 12 countries participated in the development of five guidelines for the management of venous thromboembolism by the American Society of Hematology.

Results: Ten themes corresponded to the GRADE approach and represented all panel discussions. Over half (53%) of the total panel discussions concerned the use of research evidence. When evidence was considered sufficient and clear, the decision-making process proved rapid.

Conclusion: The GRADE EtD framework provides structure to guidelines panel meetings, and ensures that the panelists consider all established formal GRADE criteria as they decide on the recommendation text, strength, and direction (for or against an intervention). This is the first study assessing the use of GRADE's EtD framework during real-time guidelines development using panel discussions. Given the widespread use of GRADE, this study provides important information for practice recommendations generated when guidelines panels explicitly follow, in a transparent and systematic manner, the structured GRADE EtD framework. By recognizing the extent to which panels discuss and consider GRADE and other (non-GRADE) criteria for producing guideline recommendations, we are one step closer to understanding the decision-making process in panels that use a structured framework such as the GRADE EtD framework.

Keywords: Clinical practice guidelines; Decision-making; Epidemiology; Evidence to Decision framework; GRADE; group processing.

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Conflict of interest statement

Conflicts of interest: The authors report no conflict of interest. S.-A.L. is the lead author of the report, a doctoral candidate. A.C. currently serves on the American Society for Hematology Committee on Quality. R.N., W.W., G.G., and H.J.S. have direct involvement in GRADE methods, working group.

Figures

Fig. 1.
Fig. 1.
Display of percentage (rounded) and frequency of words or phrases deliberated by panelists for each theme.
See this image and copyright information in PMC

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