Article type
Year
Abstract
Background: The process of moving from evidence to decisions (EtD) is an important step in guideline development. Ideally, a framework should guide this process. Various multicriteria EtD frameworks have been launched but their use has not yet been evaluated systematically.
Objectives: To identify and describe the processes and frameworks suggested for formulating recommendations in guidance documents for clinical practice guidelines development.
Methods: We searched the G-I-N library, MEDLINE, the Cochrane Methodology Register, and gray literature sources to identify guidance documents published since 2000, produced by worldwide institutions responsible for guideline development. We excluded those documents that only reported methodology for adapting, endorsing, or updating guidelines. Pairs of independent researchers selected and extracted data using a piloted case report form.
Results: This is a preliminary analysis of 37 guidance documents (mean publication year 2014, range 2004-2020). Most of the documents (22; 59%) were published by scientific societies, from the United States (14; 38%). Eleven guidance documents (30%) described a structured process for outcomes rating. Most of them (32; 86%) indicated a structured process for assessing the quality of the evidence, for which the GRADE approach was the most common one (24; 65%), followed by SIGN (3; 8%). Only one document did not provide a system for grading the strength of recommendations, whereas 25 documents (68%) indicated a structured process for formulating recommendations. More than half (22; 59%) of the documents suggested the use of the GRADE-EtD frameworks for moving from evidence to recommendations; other frameworks included SIGN (2; 5%), Oxford (2; 5%), and NICE (1; 3%).
Conclusions: Considering guidance documents for producing clinical practice guidelines, GRADE was the most widely used approach for assessing the quality of the evidence, and the GRADE-EtD frameworks were the most common ones suggested by organizations devoted to guidelines development for the process of moving from evidence to recommendations. Not all of the organizations suggest structured frameworks for the EtD process.
Patient or healthcare consumer involvement: Even though almost all the documents (34; 92%) provided guidance about the composition of the guideline panel, only 23 of them (62%) suggested the involvement of patients or consumers representatives, and six (16%) encouraged the involvement of members of the public. A wider guidance about the involvement of patients or consumers’ representatives and members of the public in clinical practice guidelines is highly encouraged.
Objectives: To identify and describe the processes and frameworks suggested for formulating recommendations in guidance documents for clinical practice guidelines development.
Methods: We searched the G-I-N library, MEDLINE, the Cochrane Methodology Register, and gray literature sources to identify guidance documents published since 2000, produced by worldwide institutions responsible for guideline development. We excluded those documents that only reported methodology for adapting, endorsing, or updating guidelines. Pairs of independent researchers selected and extracted data using a piloted case report form.
Results: This is a preliminary analysis of 37 guidance documents (mean publication year 2014, range 2004-2020). Most of the documents (22; 59%) were published by scientific societies, from the United States (14; 38%). Eleven guidance documents (30%) described a structured process for outcomes rating. Most of them (32; 86%) indicated a structured process for assessing the quality of the evidence, for which the GRADE approach was the most common one (24; 65%), followed by SIGN (3; 8%). Only one document did not provide a system for grading the strength of recommendations, whereas 25 documents (68%) indicated a structured process for formulating recommendations. More than half (22; 59%) of the documents suggested the use of the GRADE-EtD frameworks for moving from evidence to recommendations; other frameworks included SIGN (2; 5%), Oxford (2; 5%), and NICE (1; 3%).
Conclusions: Considering guidance documents for producing clinical practice guidelines, GRADE was the most widely used approach for assessing the quality of the evidence, and the GRADE-EtD frameworks were the most common ones suggested by organizations devoted to guidelines development for the process of moving from evidence to recommendations. Not all of the organizations suggest structured frameworks for the EtD process.
Patient or healthcare consumer involvement: Even though almost all the documents (34; 92%) provided guidance about the composition of the guideline panel, only 23 of them (62%) suggested the involvement of patients or consumers representatives, and six (16%) encouraged the involvement of members of the public. A wider guidance about the involvement of patients or consumers’ representatives and members of the public in clinical practice guidelines is highly encouraged.