TY - JOUR
T1 - Good or best practice statements
T2 - Proposal for the operationalisation and implementation of GRADE guidance
AU - Dewidar, Omar
AU - Lotfi, Tamara
AU - Langendam, Miranda W.
AU - Parmelli, Elena
AU - Saz Parkinson, Zuleika
AU - Solo, Karla
AU - Chu, Derek K.
AU - Mathew, Joseph L.
AU - Akl, Elie A.
AU - Brignardello-Petersen, Romina
AU - Mustafa, Reem A.
AU - Moja, Lorenzo
AU - Iorio, Alfonso
AU - Chi, Yuan
AU - Canelo-Aybar, Carlos
AU - Kredo, Tamara
AU - Karpusheff, Justine
AU - Turgeon, Alexis F.
AU - Alonso-Coello, Pablo
AU - Wiercioch, Wojtek
AU - Gerritsen, Annette
AU - Klugar, Miloslav
AU - Rojas, María Ximena
AU - Tugwell, Peter
AU - Welch, Vivian Andrea
AU - Pottie, Kevin
AU - Munn, Zachary
AU - Nieuwlaat, Robby
AU - Ford, Nathan
AU - Stevens, Adrienne
AU - Khabsa, Joanne
AU - Nasir, Zil
AU - Leontiadis, Grigorios
AU - Meerpohl, Joerg
AU - Piggott, Thomas
AU - Qaseem, Amir
AU - Matthews, Micayla
AU - Schünemann, Holger J.
N1 - Funding Information: Competing interests This work was supported by grants from Publisher Copyright: © 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - An evidence-based approach is considered the gold standard for health decision-making. Sometimes, a guideline panel might judge the certainty that the desirable effects of an intervention clearly outweigh its undesirable effects as high, but the body of supportive evidence is indirect. In such cases, the application of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach for grading the strength of recommendations is inappropriate. Instead, the GRADE Working Group has recommended developing ungraded best or good practice statement (GPS) and developed guidance under which circumsances they would be appropriate. Through an evaluation of COVID-1- related recommendations on the eCOVID Recommendation Map (COVID-19.recmap.org), we found that recommendations qualifying a GPS were widespread. However, guideline developers failed to label them as GPS or transparently report justifications for their development. We identified ways to improve and facilitate the operationalisation and implementation of the GRADE guidance for GPS. Herein, we propose a structured process for the development of GPSs that includes applying a sequential order for the GRADE guidance for developing GPS. This operationalisation considers relevant evidence-to-decision criteria when assessing the net consequences of implementing the statement, and reporting information supporting judgments for each criterion. We also propose a standardised table to facilitate the identification of GPS and reporting of their development. This operationalised guidance, if endorsed by guideline developers, may palliate some of the shortcomings identified. Our proposal may also inform future updates of the GRADE guidance for GPS.
AB - An evidence-based approach is considered the gold standard for health decision-making. Sometimes, a guideline panel might judge the certainty that the desirable effects of an intervention clearly outweigh its undesirable effects as high, but the body of supportive evidence is indirect. In such cases, the application of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach for grading the strength of recommendations is inappropriate. Instead, the GRADE Working Group has recommended developing ungraded best or good practice statement (GPS) and developed guidance under which circumsances they would be appropriate. Through an evaluation of COVID-1- related recommendations on the eCOVID Recommendation Map (COVID-19.recmap.org), we found that recommendations qualifying a GPS were widespread. However, guideline developers failed to label them as GPS or transparently report justifications for their development. We identified ways to improve and facilitate the operationalisation and implementation of the GRADE guidance for GPS. Herein, we propose a structured process for the development of GPSs that includes applying a sequential order for the GRADE guidance for developing GPS. This operationalisation considers relevant evidence-to-decision criteria when assessing the net consequences of implementing the statement, and reporting information supporting judgments for each criterion. We also propose a standardised table to facilitate the identification of GPS and reporting of their development. This operationalised guidance, if endorsed by guideline developers, may palliate some of the shortcomings identified. Our proposal may also inform future updates of the GRADE guidance for GPS.
KW - COVID-19
KW - Evidence-Based Practice
UR - http://www.scopus.com/inward/record.url?scp=85128921492&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bmjebm-2022-111962
DO - https://doi.org/10.1136/bmjebm-2022-111962
M3 - Article
C2 - 35428694
SN - 2515-446X
VL - 28
SP - 189
EP - 196
JO - BMJ evidence-based medicine
JF - BMJ evidence-based medicine
IS - 3
M1 - bmjebm-2022-111962
ER -