Can the Critical Appraisal Skills Programme check-lists be used alongside Grading of Recommendations Assessment, Development and Evaluation to improve transparency and decision-making?

Aims: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group Guidance is widely used to increase the transparency by which evidence is turned into recommendations. Although the process is clearly defined, it may be difficult to use in nursing education and practice because it uses separate terminology and tools to those sometimes used in education, such as those devised by the Critical Appraisal Skills Programme (CASP). This paper aims to show how these tools can be used together.

Design: Discussion paper.

Data Sources: Documentation from the GRADE Working Group, and the CASP, as of 14 June 2019.

Implications For Nursing: All of the items from the CASP check-list can be incorporated into GRADE which might allow for wider use of its principles in nursing education and practice. Some additions are required, however, to complete the outcome-level assessment, these being the consistency of the results and possible publication bias. More details on the extent to which the benefits are worth any harms and costs and different types of inconsistency (heterogeneity) would also be useful. This approach is consistent with the Group's Criteria for determining whether the GRADE approach was used.

Conclusion: The CASP tool can be used with minor modification to a GRADE-like manner. This would allow for GRADE to be taught and used in nursing education and transferred to practice.

Impact: This discussion paper addressed the use of the CASP Randomised Controlled Trial check-list to undertake GRADE-like assessments of evidence. With minor modifications to the way CASP is used, it is possible to use this tool to make GRADE-like assessments of the body of evidence and to critique individual studies. This finding will allow for the full use of the GRADE approach in healthcare education using the CASP tools.