Article type
Year
Abstract
Background:
The GRADE approach to guideline development entails grading the guideline recommendations as strong or weak (conditional) and rating confidence in effect estimates of intervention (quality of evidence) as high, moderate, low and very low (l/vl). GRADE suggests guideline panels seldom make strong recommendations based on l/vl confidence. Between 2007-2013 World Health Organization (WHO) guideline developers using GRADE had 60% of their recommendations as strong, and 60% of these based on l/vl evidence. Using a GRADE-developed taxonomy, we classify these recommendations as either optimal or a number of categories of sub-optimal.
Objectives:
We are now in the process of interviewing WHO guideline panel chairs to explore the thought processes of their panels in making strong recommendations based on l/vl confidence.
Methods:
We will use examples of strong recommendations that we have classified as best practice (and thus inappropriate for grading); incorrect classification of confidence as l/vl when moderate is warranted; and recommendations better classified as conditional on the basis of uncertainty in effects. One hour duration, one-on-one, semi-structured interview format (15 questions) will seek guideline panelists’ thinking and considerations they used to arrive at these strong recommendations.
Results:
Full results will be available by September 2014.
Conclusions:
A clear understanding of when and why strong recommendations are being formulated at WHO when the uncertainty is high is an important methodological issue that has implications not just for WHO, but for a wide variety of guideline development groups internationally. It may be that guideline developers perceive weak or conditional recommendations as unhelpful, considerations such as equity and local values may drive their decisions, or they may be inappropriately neglecting the uncertainty and making recommendations in accordance with their personal views and current policies and practice. The findings may warrant modifications of the GRADE approach, increased education of guideline panelists, increased attention to conflict of interest, or some combination.
The GRADE approach to guideline development entails grading the guideline recommendations as strong or weak (conditional) and rating confidence in effect estimates of intervention (quality of evidence) as high, moderate, low and very low (l/vl). GRADE suggests guideline panels seldom make strong recommendations based on l/vl confidence. Between 2007-2013 World Health Organization (WHO) guideline developers using GRADE had 60% of their recommendations as strong, and 60% of these based on l/vl evidence. Using a GRADE-developed taxonomy, we classify these recommendations as either optimal or a number of categories of sub-optimal.
Objectives:
We are now in the process of interviewing WHO guideline panel chairs to explore the thought processes of their panels in making strong recommendations based on l/vl confidence.
Methods:
We will use examples of strong recommendations that we have classified as best practice (and thus inappropriate for grading); incorrect classification of confidence as l/vl when moderate is warranted; and recommendations better classified as conditional on the basis of uncertainty in effects. One hour duration, one-on-one, semi-structured interview format (15 questions) will seek guideline panelists’ thinking and considerations they used to arrive at these strong recommendations.
Results:
Full results will be available by September 2014.
Conclusions:
A clear understanding of when and why strong recommendations are being formulated at WHO when the uncertainty is high is an important methodological issue that has implications not just for WHO, but for a wide variety of guideline development groups internationally. It may be that guideline developers perceive weak or conditional recommendations as unhelpful, considerations such as equity and local values may drive their decisions, or they may be inappropriately neglecting the uncertainty and making recommendations in accordance with their personal views and current policies and practice. The findings may warrant modifications of the GRADE approach, increased education of guideline panelists, increased attention to conflict of interest, or some combination.