Article type
Abstract
Background
Reducing research waste and improving efficiency in guideline development are important in resource-constrained settings. The Global Evidence, Local Adaptation (GELA) project used GRADE-ADOLOPMENT to develop locally relevant guidelines for child health in Malawi, Nigeria, and South Africa. This evidence-to-decision (EtD) framework-based approach to developing or adapting and contextualizing guidelines requires decisions on whether to use, update, or produce new systematic reviews to inform EtD criteria. For guideline questions prioritized in GELA, assessing effectiveness of evidence syntheses for benefits and harms criteria presented several challenges.
Objectives
To report complexities and learnings from assessing effectiveness evidence and deciding whether to use, update, or produce new systematic reviews to ensure fit-for-use evidence for EtD frameworks for 5 guideline questions in the GELA project.
Methods
We established a priori decision paths in the GELA adolopment algorithm to facilitate assessment of existing effectiveness systematic reviews for guideline questions. Decision paths focused on 3 areas: methodological rigor (AMSTAR 2), recency (missing important evidence), and availability of GRADE tables. For 3 questions, reviews underlying matched recommendations in source guidelines were assessed. For 2 without source guidelines, systematic reviews identified through scoping were assessed.
Results
Although the decision paths were a good starting point, evidence assessments were more nuanced. They required careful consideration of trade-offs across decision areas, balancing efficiency and pragmatism with fitness-for-use of evidence to inform benefits and harms EtD criteria. For example, the methodological rigor of a review needed to be weighed against it missing a relevant subpopulation. Potential inefficiencies of using reviews addressing broader populations or interventions of interest needed to be balanced against their methodological rigor. Efficient data extraction, to enable updating and GRADE assessments, was impacted by degree of reporting detail. Although decision paths steered towards updating older reviews, the value-add of updating varied.
Conclusions
For guideline adolopment, assessing evidence and deciding whether to use, update, or produce new systematic reviews to inform benefits and harms EtD criteria are often complex. Our decision paths could be further improved, but, ultimately, practical, case-specific decision-making by experienced methodologists was required.
Relevance and importance to patients
Evidence-informed guidelines impact practices and policies affecting outcomes in patients.
Reducing research waste and improving efficiency in guideline development are important in resource-constrained settings. The Global Evidence, Local Adaptation (GELA) project used GRADE-ADOLOPMENT to develop locally relevant guidelines for child health in Malawi, Nigeria, and South Africa. This evidence-to-decision (EtD) framework-based approach to developing or adapting and contextualizing guidelines requires decisions on whether to use, update, or produce new systematic reviews to inform EtD criteria. For guideline questions prioritized in GELA, assessing effectiveness of evidence syntheses for benefits and harms criteria presented several challenges.
Objectives
To report complexities and learnings from assessing effectiveness evidence and deciding whether to use, update, or produce new systematic reviews to ensure fit-for-use evidence for EtD frameworks for 5 guideline questions in the GELA project.
Methods
We established a priori decision paths in the GELA adolopment algorithm to facilitate assessment of existing effectiveness systematic reviews for guideline questions. Decision paths focused on 3 areas: methodological rigor (AMSTAR 2), recency (missing important evidence), and availability of GRADE tables. For 3 questions, reviews underlying matched recommendations in source guidelines were assessed. For 2 without source guidelines, systematic reviews identified through scoping were assessed.
Results
Although the decision paths were a good starting point, evidence assessments were more nuanced. They required careful consideration of trade-offs across decision areas, balancing efficiency and pragmatism with fitness-for-use of evidence to inform benefits and harms EtD criteria. For example, the methodological rigor of a review needed to be weighed against it missing a relevant subpopulation. Potential inefficiencies of using reviews addressing broader populations or interventions of interest needed to be balanced against their methodological rigor. Efficient data extraction, to enable updating and GRADE assessments, was impacted by degree of reporting detail. Although decision paths steered towards updating older reviews, the value-add of updating varied.
Conclusions
For guideline adolopment, assessing evidence and deciding whether to use, update, or produce new systematic reviews to inform benefits and harms EtD criteria are often complex. Our decision paths could be further improved, but, ultimately, practical, case-specific decision-making by experienced methodologists was required.
Relevance and importance to patients
Evidence-informed guidelines impact practices and policies affecting outcomes in patients.