Article type
Abstract
"Background: Evidence to decisions (EtD) framework offers a structured and explicit process in the development of healthcare recommendations. However, some guideline developers remain confused to make recommendations, particularly when evidence is deemed insufficient. Previous studies showed that although nearly half of the guideline documents provide guidance for formulating recommendations when there is insufficient evidence (low/very low-quality evidence or no evidence available), a majority of guidelines, including those from World Health Organization, have formulated discordant and inappropriate recommendations. We wanted to better understand which aspects of the guideline development manuals can be improved.
Objective: (1) What guidance provided for the formulation of healthcare recommendations when evidence is insufficient available in guidance development manuals? (2) if existing guidance are sufficient for guideline developers to make recommendations when evidence is insufficient.
Methods: We followed the methods for the conduct of a systematic survey. Through searching the Guidelines International Network library, MEDLINE, Google Scholar and The Cochrane Methodology Register using key terms such as ‘‘handbook*,’’ ‘‘guideline methodology,’’ ‘‘clinical practice guideline*, “and ‘‘manual’’, we included the latest version of methodological guidance documents, published as organization reports, journal articles, or briefs, developed by institutions responsible for guideline development in any field of healthcare. Corresponding to the research questions to answer, we designed an ad hoc data abstraction form, it covered information on the main characteristics of the guidance documents as well as the details of methodology and guidance on how to make recommendations when evidence is insufficient. Both selection and data extraction processes were undertaken independently by pairs of reviewers, with discrepancies solved by consensus or by involving a third reviewer, if needed.
Results: The search resulted in a total of 10,948 records. After removing duplicates and screening the titles, abstracts and full-texts, we included a total of 70 guideline development manuals from 15 countries. This study is ongoing and detailed results will be presented at the Colloquium.
Conclusions: Quality of evidence is a key determinant for making recommendations. However, for many clinical questions, published evidence may be limited. We need more complete and detailed guidance on how to make appropriate recommendations when evidence is insufficient."
Objective: (1) What guidance provided for the formulation of healthcare recommendations when evidence is insufficient available in guidance development manuals? (2) if existing guidance are sufficient for guideline developers to make recommendations when evidence is insufficient.
Methods: We followed the methods for the conduct of a systematic survey. Through searching the Guidelines International Network library, MEDLINE, Google Scholar and The Cochrane Methodology Register using key terms such as ‘‘handbook*,’’ ‘‘guideline methodology,’’ ‘‘clinical practice guideline*, “and ‘‘manual’’, we included the latest version of methodological guidance documents, published as organization reports, journal articles, or briefs, developed by institutions responsible for guideline development in any field of healthcare. Corresponding to the research questions to answer, we designed an ad hoc data abstraction form, it covered information on the main characteristics of the guidance documents as well as the details of methodology and guidance on how to make recommendations when evidence is insufficient. Both selection and data extraction processes were undertaken independently by pairs of reviewers, with discrepancies solved by consensus or by involving a third reviewer, if needed.
Results: The search resulted in a total of 10,948 records. After removing duplicates and screening the titles, abstracts and full-texts, we included a total of 70 guideline development manuals from 15 countries. This study is ongoing and detailed results will be presented at the Colloquium.
Conclusions: Quality of evidence is a key determinant for making recommendations. However, for many clinical questions, published evidence may be limited. We need more complete and detailed guidance on how to make appropriate recommendations when evidence is insufficient."