Systematic reviews of prognostic studies 5: using GRADE in systematic reviews of studies on overall prognosis

Article type
Authors
Iorio A1, Matovinovic E2, Hayden J3, Schunemann H4, Guyatt G4, Williams K5, Moons C6
1McMaster University
2Cochrane Gynecology and Fertility/ GRADE Working Group
3Back Review Group; Prognosis Methods Group
4McMaster University, Canada
5Department of Paediatrics, University of Melbourne; Developmental Medicine, Royal Children’s Hospital; Murdoch Childrens Research Institute, Melbourne, Australia
6Julius Center, Utrecth, The Netherlands
Abstract
Objectives: To enable participants to:
1. know the principles of the GRADE approach to prognosis;
2. be able to prepare evidence profiles (EPs) and 'Summary of findings' tables for prognostic questions addressing broad populations.
Systematic reviews (SR) of observational studies addressing patients' prognosis may provide robust estimates of the likelihood of adverse outcomes in broad populations. As in any SR, consumers require estimates of the certainty of evidence (synonyms: confidence in or quality of evidence). Until recently structured approaches to judging certainty in prognostic studies have been unavailable. Using GRADE methodology we have presented structured approaches to rating certainty of evidence from prognostic studies applied to broad populations (Iorio A. BMJ 2015;350:e870; Spencer F. BMJ 2012;345:e7401). We are currently working on approaches to studies of individual prognostic factors and plan to develop approaches for prognostic models.
Description: In this workshop we will summarize the approach to broad population prognosis we have developed and work through examples. We will begin with a description of how to apply five elements of rating certainty to prognostic studies: risk of bias, precision, consistency, directness and publication bias. Participants will then compile an EP on a prognostic SR. Finally, we will discuss of how such summaries of evidence can be applied to a patient management decision.