Kevin Pottie1, Vivian Welch2, Rachael Morton3, Elie A Akl4, Javier H Eslava-Schmalbach5, Vittal Katikireddi6, Jasvinder Singh7, Lorenzo Moja8, Eddy Lang9, Nicola Magrini8, Lehana Thabane10, Roger Stanev11, Elizabeth Matovinovic12, Alexandra Snellman13, Matthias Briel14, Beverly Shea15, Peter Tugwell16, Holger Schunemann17, Gordon Guyatt18, Pablo Alonso-Coello19. 1. Departments of Family Medicine and Epidemiology and Community Medicine, Bruyere Research Institute University of Ottawa, Ottawa, Ontario, Canada; Epidemiology and Community Medicine, Bruyere Research Institute University of Ottawa, Ottawa, Ontario, Canada. Electronic address: kpottie@uottawa.ca. 2. University of Ottawa, Ottawa, Ontario, Canada. 3. NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia. 4. Department of Internal Medicine, American University of Beirut, Lebanon. 5. Group of Equity in Health, Faculty of Medicine, Universidad Nacional de Colombia, Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion, Bogotá, Colombia. 6. Public Health, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland. 7. University of Alabama, Alabama, USA. 8. Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland. 9. Division of Emergency Medicine, Department of Family Medicine, University of Calgary, Calgary, Canada. 10. Department of Clinical Epidemiology and Biostatistics, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 11. Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Philosophy, Ottawa, Ontario, Canada. 12. Faculty of Medicine, Chiang Mai University, Thailand. 13. Swedish Agency for Health Technology Assessment and Assessment of Social Services. 14. Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Switzerland; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. 15. Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada. 16. Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 17. Department of Health Research Methods, Evidence, and Impact and of Medicine, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada. 18. Department of Health Research Methods, Evidence, and Impact and of Medicine, McMaster University Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada. 19. Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (CIBERESP-IIB Sant Pau), Barcelona, España.
Abstract
OBJECTIVES: The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading Recommendations Assessment and Development Evidence) evidence to decision process. STUDY DESIGN AND SETTING: We developed this guidance based on the GRADE evidence to decision framework, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. RESULTS: Considering the impact on health equity may be required, both in general guidelines and guidelines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. CONCLUSION: Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup.
OBJECTIVES: The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading Recommendations Assessment and Development Evidence) evidence to decision process. STUDY DESIGN AND SETTING: We developed this guidance based on the GRADE evidence to decision framework, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. RESULTS: Considering the impact on health equity may be required, both in general guidelines and guidelines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. CONCLUSION: Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup.
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