Nancy Santesso1, Alonso Carrasco-Labra2, Miranda Langendam3, Romina Brignardello-Petersen4, Reem A Mustafa5, Pauline Heus6, Toby Lasserson7, Newton Opiyo7, Ilkka Kunnamo8, David Sinclair9, Paul Garner10, Shaun Treweek11, David Tovey7, Elie A Akl12, Peter Tugwell13, Jan L Brozek14, Gordon Guyatt14, Holger J Schünemann15. 1. Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. 2. Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Independencia, Santiago, Chile. 3. Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, PO Box 22660, J1B-211, 1100 DD Amsterdam, The Netherlands. 4. Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Independencia, Santiago, Chile; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Department of Medicine/Nephrology, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA. 5. Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine/Nephrology, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA; Department of Biomedical & Health Informatics, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA. 6. Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer Street 6.131, Postbus 85500, 3508 GA Utrecht, The Netherlands. 7. Cochrane Editorial Unit, St Albans House, 57-59 Haymarket, London SW1Y 4QX, UK. 8. Department of General Practice and Primary Health Care, Duodecim Medical Publications Ltd and University of Helsinki, PO Box 874, Kaivokatu 10 A, 7th Floor, FIN-00101 Helsinki, Finland. 9. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. 10. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; Cochrane Infectious Diseases Group, Pembroke Place, Liverpool L3 5QA, UK. 11. Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK. 12. Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, Riad-El-Solh, PO Box 11-0236, Beirut 1107 2020, Lebanon. 13. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada. 14. Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. 15. Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: schuneh@mcmaster.ca.
Abstract
BACKGROUND: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is widely used and reliable and accurate for assessing the certainty in the body of health evidence. The GRADE working group has provided detailed guidance for assessing the certainty in the body of evidence in systematic reviews and health technology assessments (HTAs) and how to grade the strength of health recommendations. However, there is limited advice regarding how to maximize transparency of these judgments, in particular through explanatory footnotes or explanations in Summary of Findings tables and Evidence Profiles (GRADE evidence tables). METHODS: We conducted this study to define the essential attributes of useful explanations and to develop specific guidance for explanations associated with GRADE evidence tables. We used a sample of explanations according to their complexity, type of judgment involved, and appropriateness from a database of published GRADE evidence tables in Cochrane reviews and World Health Organization guidelines. We used an iterative process and group consensus to determine the attributes and develop guidance. RESULTS: Explanations in GRADE evidence tables should be concise, informative, relevant, easy to understand, and accurate. We provide general and domain-specific guidance to assist authors with achieving these desirable attributes in their explanations associated with GRADE evidence tables. CONCLUSIONS: Adhering to the general and GRADE domain-specific guidance should improve the quality of explanations associated with GRADE evidence tables, assist authors of systematic reviews, HTA reports, or guidelines with information that they can use in other parts of their evidence synthesis. This guidance will also support editorial evaluation of evidence syntheses using GRADE and provide a minimum quality standard of judgments across tables.
BACKGROUND: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is widely used and reliable and accurate for assessing the certainty in the body of health evidence. The GRADE working group has provided detailed guidance for assessing the certainty in the body of evidence in systematic reviews and health technology assessments (HTAs) and how to grade the strength of health recommendations. However, there is limited advice regarding how to maximize transparency of these judgments, in particular through explanatory footnotes or explanations in Summary of Findings tables and Evidence Profiles (GRADE evidence tables). METHODS: We conducted this study to define the essential attributes of useful explanations and to develop specific guidance for explanations associated with GRADE evidence tables. We used a sample of explanations according to their complexity, type of judgment involved, and appropriateness from a database of published GRADE evidence tables in Cochrane reviews and World Health Organization guidelines. We used an iterative process and group consensus to determine the attributes and develop guidance. RESULTS: Explanations in GRADE evidence tables should be concise, informative, relevant, easy to understand, and accurate. We provide general and domain-specific guidance to assist authors with achieving these desirable attributes in their explanations associated with GRADE evidence tables. CONCLUSIONS: Adhering to the general and GRADE domain-specific guidance should improve the quality of explanations associated with GRADE evidence tables, assist authors of systematic reviews, HTA reports, or guidelines with information that they can use in other parts of their evidence synthesis. This guidance will also support editorial evaluation of evidence syntheses using GRADE and provide a minimum quality standard of judgments across tables.
Authors: Paraskevi Massara; Andreea Zurbau; Andrea J Glenn; Laura Chiavaroli; Tauseef A Khan; Effie Viguiliouk; Sonia Blanco Mejia; Elena M Comelli; Victoria Chen; Ursula Schwab; Ulf Risérus; Matti Uusitupa; Anne-Marie Aas; Kjeld Hermansen; Inga Thorsdottir; Dario Rahelić; Hana Kahleová; Jordi Salas-Salvadó; Cyril W C Kendall; John L Sievenpiper Journal: Diabetologia Date: 2022-08-26 Impact factor: 10.460
Authors: Julia Schumann; Eva C Henrich; Hellen Strobl; Roland Prondzinsky; Sophie Weiche; Holger Thiele; Karl Werdan; Stefan Frantz; Susanne Unverzagt Journal: Cochrane Database Syst Rev Date: 2018-01-29
Authors: James K Jewer; Michael J Wong; Sally J Bird; Ashraf S Habib; Robin Parker; Ronald B George Journal: Cochrane Database Syst Rev Date: 2019-03-29
Authors: Carlijn R Hooijmans; Rob B M de Vries; Merel Ritskes-Hoitinga; Maroeska M Rovers; Mariska M Leeflang; Joanna IntHout; Kimberley E Wever; Lotty Hooft; Hans de Beer; Ton Kuijpers; Malcolm R Macleod; Emily S Sena; Gerben Ter Riet; Rebecca L Morgan; Kristina A Thayer; Andrew A Rooney; Gordon H Guyatt; Holger J Schünemann; Miranda W Langendam Journal: PLoS One Date: 2018-01-11 Impact factor: 3.240
Authors: Holger J Schünemann; Joanne Khabsa; Karla Solo; Assem M Khamis; Romina Brignardello-Petersen; Amena El-Harakeh; Andrea Darzi; Anisa Hajizadeh; Antonio Bognanni; Anna Bak; Ariel Izcovich; Carlos A Cuello-Garcia; Chen Chen; Ewa Borowiack; Fatimah Chamseddine; Finn Schünemann; Gian Paolo Morgano; Giovanna E U Muti-Schünemann; Guang Chen; Hong Zhao; Ignacio Neumann; Jan Brozek; Joel Schmidt; Layal Hneiny; Leila Harrison; Marge Reinap; Mats Junek; Nancy Santesso; Rayane El-Khoury; Rebecca Thomas; Robby Nieuwlaat; Rosa Stalteri; Sally Yaacoub; Tamara Lotfi; Tejan Baldeh; Thomas Piggott; Yuan Zhang; Zahra Saad; Bram Rochwerg; Dan Perri; Eddy Fan; Florian Stehling; Imad Bou Akl; Mark Loeb; Paul Garner; Stephen Aston; Waleed Alhazzani; Wojciech Szczeklik; Derek K Chu; Elie A Akl Journal: Ann Intern Med Date: 2020-05-22 Impact factor: 25.391
Authors: Konstantin Uhlig; Ljupcho Efremov; Jörn Tongers; Stefan Frantz; Rafael Mikolajczyk; Daniel Sedding; Julia Schumann Journal: Cochrane Database Syst Rev Date: 2020-11-05