Good or best practice statements: proposal for the operationalisation and implementation of GRADE guidance

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, 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. 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. 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.

DEWIDAR Omar;  LOTFI Tamara;  LANGENDAM Miranda;  PARMELLI Elena;  SAZ PARKINSON Zuleika;  SOLO Karla;  CHU Derek K;  MATHEW Joseph;  AKL Elie;  BRIGARDELLO-PETERSEN Romina;  MUSTAFA Reem A.;  MOJA Lorenzo;  IORIO Alfonso;  CHI Yuan;  CANELO-AYBAR Carlos;  KREDO Tamara;  KARPUSHEFF Justine;  TURGEON Alexis F;  ALONSO-COELLO Pablo;  WIERCIOCH Wojtek;  GERRITSEN Annette;  KLUGAR Miloslav;  ROJAS María X;  TUGWELL Peter;  WELCH Vivian;  POTTIE Kevin;  MUNN Zachary;  NIEUWLAAT Robby;  FORD Nathan;  STEVENS Adrienne;  KHABSA Joanne;  NASIR Zil;  LEONTIADIS Grigorios;  MEERPOHL Joerg;  PIGGOTT Thomas;  QASEEM Amir;  MATTHEWS Micayla;  SCHÜNEMANN Holger; 

2023-07-13

BMJ PUBLISHING GROUP

JRC128463

2515-446X (online),   

https://pubmed.ncbi.nlm.nih.gov/35428694/,    https://publications.jrc.ec.europa.eu/repository/handle/JRC128463,   

10.1136/bmjebm-2022-111962 (online),