Article type
Abstract
Background: Decisions about environmental and occupational health (EOH) interventions impact broad and diverse groups of stakeholders with serious consequences, yet they are often based on very uncertain evidence. There is no prevailing approach to integrating research evidence, such as the output of a hazard identification or risk characterization process, with additional decision factors in EOH. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision (EtD) frameworks support decision-makers in developing informed, transparent judgements when choosing between different options. These frameworks facilitate consideration of potential desirable and undesirable health effects (benefits and harms) while also systematically taking into account values, equity, acceptability, and feasibility of different alternatives.
Objectives: To introduce new GRADE Guidance for a GRADE EtD framework that is tailored to EOH decision scenarios such as setting exposure thresholds or informing regulatory decisions
Methods: We conducted a systematic review and narrative synthesis of published and public EOH decision frameworks, followed by a modified Delphi process leading to development of a draft GRADE EtD framework for EOH. We pilot tested the provisional framework through a virtual workshop series, which further informed guidance for the framework’s application. We presented a summary of the results to all attendees of the GRADE Working Group meeting for feedback in July 2022 and November 2022, and for approval in May 2023 as GRADE Guidance.
Results: Consistent with existing GRADE EtD frameworks, the EtD framework for EOH includes a scoping and contextualization process and 12 assessment criteria. Modifications to the existing EtD frameworks include consideration of the sociopolitical context when making judgments about the priority of the problem and feasibility of different alternatives; the addition of timing when making judgments about benefits and harms, the balance of effects, and feasibility; broadening of the equity criterion to include considerations beyond health equity; and more explicit accommodation of variable or conflicting stakeholder views when considering values and acceptability.
Conclusions: Policymakers, regulators, and other stakeholders should use this GRADE EtD framework as the basis for a standardized approach to decision-making about environmental and occupational exposures and interventions.
Objectives: To introduce new GRADE Guidance for a GRADE EtD framework that is tailored to EOH decision scenarios such as setting exposure thresholds or informing regulatory decisions
Methods: We conducted a systematic review and narrative synthesis of published and public EOH decision frameworks, followed by a modified Delphi process leading to development of a draft GRADE EtD framework for EOH. We pilot tested the provisional framework through a virtual workshop series, which further informed guidance for the framework’s application. We presented a summary of the results to all attendees of the GRADE Working Group meeting for feedback in July 2022 and November 2022, and for approval in May 2023 as GRADE Guidance.
Results: Consistent with existing GRADE EtD frameworks, the EtD framework for EOH includes a scoping and contextualization process and 12 assessment criteria. Modifications to the existing EtD frameworks include consideration of the sociopolitical context when making judgments about the priority of the problem and feasibility of different alternatives; the addition of timing when making judgments about benefits and harms, the balance of effects, and feasibility; broadening of the equity criterion to include considerations beyond health equity; and more explicit accommodation of variable or conflicting stakeholder views when considering values and acceptability.
Conclusions: Policymakers, regulators, and other stakeholders should use this GRADE EtD framework as the basis for a standardized approach to decision-making about environmental and occupational exposures and interventions.