Abstract
BackgroundJudgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report guideline developers’ judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels.MethodsFollowing the guideline panel meetings, we asked methodologists participating in the panel to provide feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback collected from the rest of the panel. Two investigators independently summarized the responses and jointly interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results and provide further input to improve the structure of the EtDs iteratively.ResultsThe EtD framework was well received, and the comments were generally positive. Methodologists felt that in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in an explicit and transparent way. However, some sections (e.g., “values and preferences” and “balance between benefits and harms”) required further development and clarification that were considered in the current version of the EtD framework.ConclusionsThe use of an EtD framework in guideline development offers a structured and explicit way to record and report the judgments and discussion of guideline panels during the formulation of recommendations. In addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in research.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0462-y) contains supplementary material, which is available to authorized users.
Highlights
Judgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion
We report on the first experience with the Evidence-to-Decision Framework (EtD) framework for clinical recommendations in real guideline panels
Our findings strongly suggest that the EtD framework can enhance the transparency of guideline developers’ judgments, allowing decision makers to truly assess the recommendation
Summary
Judgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. In order to be trustworthy, guidelines need to be explicit regarding the methods used to summarize the evidence and rate its certainty ( known as quality of the evidence or confidence in the effect estimates) and about the judgments involved in moving from evidence to recommendations [5,6,7] Such judgments are rarely recorded and presented in a systematic way. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group (www.gra deworkinggroup.org), a collaborative of over 500 scientists, clinicians, and people with other backgrounds, has developed an approach to assessing the certainty in the body of evidence summarized in systematic reviews that support a decision or guideline recommendation, called the GRADE approach [8, 9]. Another methodologist suggested expanding the content to include more information about each particular outcome
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