Abstract
ObjectiveTo develop guidance on what information to include and how to present it in tables summarizing the evidence from systematic reviews of test accuracy following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.MethodsTo design and refine the evidence tables, we used an iterative process based on the analysis of data from four rounds of discussions, feedback and user testing. During the final round, we conducted one-on-one user testing with target end users. We presented a number of alternative formats of evidence tables to participants and obtained information about users’ understanding and preferences.ResultsMore than 150 users participated in initial discussions and provided their formal and informal feedback. 20 users completed one-on-one user testing interviews. Almost all participants preferred summarizing the results of systematic reviews of test accuracy in tabular format rather than plain text. Users generally preferred less complex tables but found presenting sensitivity and specificity estimates only as too simplistic. Users found the presentation of test accuracy for several values of prevalence initially confusing but modifying table layout and adding sample clinical scenarios for each prevalence reduced this confusion. Providing information about clinical consequences of testing result was viewed as not feasible for authors of systematic reviews.ConclusionWe present the current formats for tables presenting test accuracy following the GRADE approach. These tables can be developed using GRADEpro guidelines development tool (www.guidelinedevelopment.org or www.gradepro.org) and are being further developed into electronic interactive tables that will suit the needs of different end users. The formatting of these tables, and how they influence result interpretation and decision-making will be further evaluated in a randomized trial.
Highlights
The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group’s approach to assessing evidence and developing health care recommendations has been adopted by over 90 organizations worldwide, including the World Health Organization and the National Institute for Health and Care Excellence in the UK
In this article we present the research supporting the development of GRADE diagnostic evidence tables that display the results of test accuracy (TA) systematic reviews
In this article we presented the results of extensive user testing that led to the development of the current formats of the evidence tables for test accuracy as suggested by the GRADE approach
Summary
A key GRADE output are evidence summaries (including summary of findings table and evidence profiles) that are intended to provide succinct, consumable information about intervention effects on the most important health outcomes for decision making, the quality of evidence (certainty or confidence in the effect estimates) and magnitude of such effects.[1, 2] In this article we describe research supporting the development and modifications of GRADE tables summarizing the evidence about test accuracy (TA) based on systematic reviews. We aim to provide an overview of the remaining challenges in presenting TA systematic review results for users in preparation for follow-up work in this area. Systematic reviews and meta-analysis of TA summarize the available evidence and assess its quality (certainty or confidence in the effect estimates). TA systematic reviews typically focus on tests to establish the presence or absence of a disease, condition or syndrome, and on tests that categorize results as positive or negative
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