Using evidence to make decisions in guideline development: The Evidence to Decision Framework (EtD)

ID: 

18951

Session: 

Long oral session 24: Making recommendations for guidelines

Date: 

Saturday 16 September 2017 - 14:00 to 15:30

Location: 

Meeting Room 1.43

All authors in correct order:

Santesso N1, Nuemann I2, Alonso-Coello P3, Mustafa R4, Brozek J5, Schunemann H1
1 Cochrane Canada, GRADEing Methods Group, McMaster University, Canada
2 Pontificia Universidad Catolica de Chile, Santiago, Chile, chile
3 Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain, Spain
4 GRADEing Methods Group, University of Missouri-Kansas City, United States of America
5 GRADEing Methods Group, McMaster University, Canada
Presenting author and contact person

Presenting author:

Nancy Santesso

Contact person:

Nancy Santesso
Abstract text
Background: Experiences with decision makers often reveal that there are certain criteria that are used to make decisions. However, decision makers may omit important criteria or not use the best-available evidence in the decision-making process, whether making clinical and public health recommendations (in guidelines), or coverage decisions.

Objectives: To develop and evaluate a tool to facilitate the use of evidence in decision making for guideline development.

Methods: The Evidence to Decision (EtD) Framework was developed through the work of the GRADE Working Group in the DECIDE project (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence). It was tested in a series of 15 guideline panels to develop guidelines about treatments and for screening tests. Feedback was provided by methodologists and responses were summarised and interpreted using pre-specified domains and applied to revise the EtD framework. The framework continues to be used and refined.

Results: A tool for guideline developers and users to present evidence about criteria important to decision making and to use evidence to make recommendations was developed and revised. Feedback from methodologists was generally positive and indicates that the framework helps to structure the process of making decisions by asking groups to carefully consider the criteria systematically and transparently record the process. The EtD Framework includes criteria covering evidence for benefits and harms, patient values and preferences, costs and resources, acceptability, equity issues and feasibility. EtDs have been developed for decisions about treatments and tests, and for clinical, public health and coverage decisions.

Conclusions: The EtD has been used with guideline groups to make recommendations and was revised according to feedback. The EtD is available as an interactive version and available for use and presentation in the GRADEpro online software. It is also used to produce recommendations in a format for clinicians and patients, and in Apps for use at the point of care.