Objective: To describe the Grading of Recommendations Assessment, Development and Evaluation (GRADE) interactive Evidence to Decision (EtD) frameworks for tests and test strategies for clinical, public health or coverage decisions.
Study Design And Setting: As part of the GRADE Working Group's DECIDE project we conducted workshops, user testing with systematic review authors, guideline developers and other decision makers, and piloted versions of the EtD framework.
Results: EtD frameworks for tests share the structure, explicitness, and transparency of other EtD frameworks. They require specifying the purpose of the test, linked or related management and the key outcomes of concern for different test results and subsequent management. The EtD criteria address test accuracy and assessments of the certainty of the additional evidence necessary for decision-making. When there is no direct evidence of test effects on patient important outcomes, formal or informal modeling is needed to estimate effects. We describe the EtD criteria based on examples developed with GRADEpro (www.gradepro.org), GRADE's software that also provides interactive Summary of Findings Tables.
Conclusion: EtD frameworks for developing recommendations and making decisions about tests lay out the sequential steps in reviewing and assessing the different types of evidence that need to be linked.
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http://dx.doi.org/10.1016/j.zefq.2018.03.004 | DOI Listing |
J Clin Epidemiol
December 2024
Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4 - 20090 Pieve Emanuele (Milano) Italy; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany. Electronic address:
Objective: The evaluation of health benefits and harms of an intervention with GRADE Evidence to Decision (EtD) frameworks includes judgments if the effects are "trivial", "small", "moderate" or "large". Such judgments ideally require the a priori establishment of decision thresholds (DTs), whose empirical derivation for single outcomes has been previously described. In this article, we provide a methodological approach to estimate DTs for composite endpoints based on disutilities.
View Article and Find Full Text PDFJ Clin Epidemiol
December 2024
Michael G. DeGroote Cochrane Canada & McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada; Clinical Epidemiology and Research Center (CERC), Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy. Electronic address:
Introduction: GRADE and other Evidence to Decision (EtD) frameworks are widely used by guideline development groups (GDG) and other decision-makers. When GDGs judge the magnitude of desirable and undesirable health outcomes on EtDs, they typically categorize them as trivial, small, moderate or large. However, generic judgment or decision thresholds (DTs) that could guide the user about such estimates of effect size or serve as references for interpretation of findings are not yet available.
View Article and Find Full Text PDFJ Evid Based Med
November 2024
Department of Hypertension and Endocrinology, Army Medical University, Chongqing, China.
Both hypertension and type 2 diabetes are attributable to premature death, cardiovascular and kidney diseases with largely overlapping population. Followed the GRADE approach, this expert consensus aimed to reduce the cardiovascular and kidney death and disability due to hypertension and minimize the treatment burden in adults with type 2 diabetes. Through online survey and discussion, a multidisciplinary team comprehensively prioritized seven key guideline questions.
View Article and Find Full Text PDFNeurol Sci
October 2024
Pediatric Critical Care Unit, Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
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