Article type
Abstract
Background: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) framework provides a structured and transparent approach for making health decisions or recommendations. Understanding how stakeholders use the EtD framework will inform how to provide future training and support.
Objectives: To identify the key characteristics of how the GRADE EtD framework is used and identify studies on perception of use
Methodology: The JBI methodology for scoping reviews was followed. Both peer review and gray literature were included. We searched MEDLINE and Embase (Elsevier) for studies on the use/experience of using EtD frameworks from 2015 to April 2023. Three researchers conducted screening (using Covidence) and extracted data. Data were summarized descriptively. Data extraction for a random sample (n = 200) of publicly available populated EtD frameworks identified from databases of GRADE guidelines (eg, the GIN library, BIGG database) is ongoing and not reported here.
Results: We identified 14 eligible peer-reviewed articles (8 qualitative, 4 quantitative [surveys], and 2 mixed methods) conducted internationally. Participants included methodologists, clinical experts, and GRADE Working Group members. Most studies reported using the framework to structure panel meetings. Use of the EtD framework was reported to improve agreement of panel members in making recommendations, and overall, included participants reported its importance in fostering shared understandings. Variation in how components within the framework are being used was identified, with some items being discussed more than others (eg, research evidence occupied 53.1% of discussions, while health equity occupied 2%). Prior knowledge and training were identified as necessary for panel members to apply the framework in decision-making.
Discussion/conclusions: This scoping review demonstrates that guideline development panels perceive the GRADE EtD framework positively as a tool for decision-making. Findings also indicate that there is variation in what components are used in guideline discussions and that prior training in the framework is required. Data from the published EtD frameworks will highlight the types and sources of evidence used to complete EtD frameworks internationally. Review findings will be used to inform future guidance and requirements for using the GRADE EtD framework, as well as training on how to consider the criteria in developing recommendations.
Objectives: To identify the key characteristics of how the GRADE EtD framework is used and identify studies on perception of use
Methodology: The JBI methodology for scoping reviews was followed. Both peer review and gray literature were included. We searched MEDLINE and Embase (Elsevier) for studies on the use/experience of using EtD frameworks from 2015 to April 2023. Three researchers conducted screening (using Covidence) and extracted data. Data were summarized descriptively. Data extraction for a random sample (n = 200) of publicly available populated EtD frameworks identified from databases of GRADE guidelines (eg, the GIN library, BIGG database) is ongoing and not reported here.
Results: We identified 14 eligible peer-reviewed articles (8 qualitative, 4 quantitative [surveys], and 2 mixed methods) conducted internationally. Participants included methodologists, clinical experts, and GRADE Working Group members. Most studies reported using the framework to structure panel meetings. Use of the EtD framework was reported to improve agreement of panel members in making recommendations, and overall, included participants reported its importance in fostering shared understandings. Variation in how components within the framework are being used was identified, with some items being discussed more than others (eg, research evidence occupied 53.1% of discussions, while health equity occupied 2%). Prior knowledge and training were identified as necessary for panel members to apply the framework in decision-making.
Discussion/conclusions: This scoping review demonstrates that guideline development panels perceive the GRADE EtD framework positively as a tool for decision-making. Findings also indicate that there is variation in what components are used in guideline discussions and that prior training in the framework is required. Data from the published EtD frameworks will highlight the types and sources of evidence used to complete EtD frameworks internationally. Review findings will be used to inform future guidance and requirements for using the GRADE EtD framework, as well as training on how to consider the criteria in developing recommendations.