Journal Article

GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines

Davoli, Marina, Schünemann, Holger J, Mustafa, Reem A, Akl, Elie A, Moberg, Jenny, Oxman, Andrew D, Meerpohl, Joerg, Alonso-Coello, Pablo, Guyatt, Gordon H, Treweek, Shaun, Vandvik, Per O, Brignardello-Petersen, Romina

2016

Overview

Correspondence to: P Alonso-Coello [e-mail] Summary points Clinicians do not have the time or resources to consider the underlying evidence for the myriad decisions they must make each day and, as a consequence, rely on recommendations from clinical practice guidelines Guideline panels should consider all the relevant factors (criteria) that influence a decision or recommendation in a structured, explicit, and transparent way and provide clinicians with clear and actionable recommendations The GRADE working group has developed Evidence to Decision (EtD) frameworks for different types of decisions and recommendations. In this article we will describe EtD frameworks for clinical practice recommendations The general structure of the EtD framework for clinical recommendations is similar to EtD frameworks for other types of recommendations and decisions, and includes formulation of the question, an assessment of the different criteria, and conclusions Clinical recommendations require considering criteria differently, depending on whether an individual patient or a population perspective is taken. To ensure trustworthiness, clinical practice guidelines are made by groups of people (guideline panels) with relevant skills, perspectives, and knowledge; they are informed by the best available evidence; and they are systematically developed.1 2 3 4 In the first article in this series, we described GRADE Evidence to Decision (EtD) frameworks and their rationale for different types of decisions.5 In this second article, we describe the use of EtD frameworks for clinical recommendations and how they can help clinicians and patients who use those recommendations. Death, stroke, major bleeding, myocardial infarction, treatment burden Setting: High resource setting Perspective: Health system Subgroups: Patients who are well controlled with warfarin Background: Warfarin reduces the risk for ischaemic stroke in patients with atrial fibrillation but increases the risk for haemorrhage and requires frequent blood tests and clinic visits to monitor the international normalised ratio (INR) and adjust the dose.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD
• Subject: Anticoagulants / Blood tests / Cardiac arrhythmia / Cerebral infarction / Choice Behavior / Clinical medicine / Clinical practice guidelines / Cost-Benefit Analysis / Costs / Decision Making / Evidence-Based Medicine / Health Plan Implementation - methods / Hemorrhage / Humans / Ischemia / Myocardial infarction / Patients / Practice Guidelines as Topic / Program Development / Public health / Research Methods & Reporting / Stroke / Warfarin / Working groups