A Framework for Choosing Between Multiple Interventions in Guidelines

Article type
Piggott T1, Schünemann H1
1Department of HEI, McMaster University
Background: guidelines that are developed with the GRADE approach may encounter situations where multiple interventions exist for a given topic. In these scenarios guideline groups should compare all these interventions in order to be useful to the users who will themselves have to choose between multiple interventions available to them.

Objectives: our objective is to systematically develop a methodology and software solution for comparing and choosing between multiple interventions in guideline recommendations.

Methods: we used a stakeholder-driven process to iteratively develop a multiple intervention comparison GRADE Evidence to Decisions (EtD) framework and an accompanying software tool. We involved guideline development stakeholders in a series of group meetings to generate a preliminary framework. We refined this framework in user testing and finally applied the framework and tool in two guideline development efforts for the European Commission and the World Health Organization.

Results: we identified three scenarios where guideline groups may develop recommendations on multiple interventions depending on 1) when the need to compare multiple interventions is identified and 2) whether a network meta-analysis was conducted to compare the interventions quantitatively. We applied the multiple comparison GRADE EtD framework in two international guideline groups: World Health Organization’s Infection Prevention and Control in Clinical and Programmatic Management of Tuberculosis, and the European Commission’s Initiative on Breast Cancer. We also present the application that we developed in GRADE’s software GRADEpro GDT to facilitate the comparison of multiple interventions.

Conclusions: the multi-comparison tool allows guideline groups to transparently and critically consider multiple options before them for a given health guideline topic.

Consumer Involvement: we involved guideline developers in a working group to listen to consumer needs and used a stakeholder-driven process to develop this framework and software solution to facilitate guideline development when multiple comparisons need to be assessed.