Benjamin Djulbegovic1, Tea Reljic2, Shira Elqayam3, Adam Cuker4, Iztok Hozo5, Qi Zhou6, Shelly-Anne Li7, Paul Alexander6, Robby Nieuwlaat6, Wojtek Wiercioch6, Holger Schünemann6, Gordon Guyatt6. 1. Department of Supportive Care Medicine, City of Hope, 1500 East Duarte Rd, Duarte, CA, USA; Department of Hematology, City of Hope, 1500 East Duarte Rd, Duarte, CA, USA. Electronic address: bdjulbegovic@coh.org. 2. Department of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, USA. 3. Department of Medicine, De Montfort University, Leicester, UK. 4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Mathematics, Indiana University, Gary, IN, USA. 6. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 7. Faculty of Nursing, University of Toronto, Canada.
Abstract
BACKGROUND AND OBJECTIVES: The determinants of guideline panels' recommendations remain uncertain. The objective of this study was to investigate factors considered by members of 8 panels convened by the American Society of Hematology (ASH) to develop guidelines using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. STUDY DESIGN AND SETTING: Web-based survey of the participants in the ASH guidelines panels. ANALYSIS: two-level hierarchical, random-effect, multivariable regression analysis to explore the relation between GRADE and non-GRADE factors and strength of recommendations (SOR). RESULTS: In the primary analysis, certainty in evidence [OR = 1.83; (95CI% 1.45-2.31)], balance of benefits and harms [OR = 1.49 (95CI% 1.30-1.69)] and variability in patients' values and preferences [OR = 1.47 (95CI% 1.15-1.88)] proved the strongest predictors of SOR. In a secondary analysis, certainty of evidence was associated with a strong recommendation [OR = 3.60 (95% CI 2.16-6.00)] when panel members recommended "for" interventions but not when they made recommendations "against" interventions [OR = 0.98 (95%CI: 0.57-1.8)] consistent with "yes" bias. Agreement between individual members and the group in rating SOR varied (kappa ranged from -0.01 to 0.64). CONCLUSION: GRADE's conceptual framework proved, in general, to be highly associated with SOR. Failure of certainty of evidence to be associated with SOR against an intervention, suggest the need for improvements in the process.
BACKGROUND AND OBJECTIVES: The determinants of guideline panels' recommendations remain uncertain. The objective of this study was to investigate factors considered by members of 8 panels convened by the American Society of Hematology (ASH) to develop guidelines using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. STUDY DESIGN AND SETTING: Web-based survey of the participants in the ASH guidelines panels. ANALYSIS: two-level hierarchical, random-effect, multivariable regression analysis to explore the relation between GRADE and non-GRADE factors and strength of recommendations (SOR). RESULTS: In the primary analysis, certainty in evidence [OR = 1.83; (95CI% 1.45-2.31)], balance of benefits and harms [OR = 1.49 (95CI% 1.30-1.69)] and variability in patients' values and preferences [OR = 1.47 (95CI% 1.15-1.88)] proved the strongest predictors of SOR. In a secondary analysis, certainty of evidence was associated with a strong recommendation [OR = 3.60 (95% CI 2.16-6.00)] when panel members recommended "for" interventions but not when they made recommendations "against" interventions [OR = 0.98 (95%CI: 0.57-1.8)] consistent with "yes" bias. Agreement between individual members and the group in rating SOR varied (kappa ranged from -0.01 to 0.64). CONCLUSION: GRADE's conceptual framework proved, in general, to be highly associated with SOR. Failure of certainty of evidence to be associated with SOR against an intervention, suggest the need for improvements in the process.
Authors: Diana B Petitti; Steven M Teutsch; Mary B Barton; George F Sawaya; Judith K Ockene; Thomas DeWitt Journal: Ann Intern Med Date: 2009-02-03 Impact factor: 25.391
Authors: Jeffrey C Andrews; Holger J Schünemann; Andrew D Oxman; Kevin Pottie; Joerg J Meerpohl; Pablo Alonso Coello; David Rind; Victor M Montori; Juan Pablo Brito; Susan Norris; Mahmoud Elbarbary; Piet Post; Mona Nasser; Vijay Shukla; Roman Jaeschke; Jan Brozek; Ben Djulbegovic; Gordon Guyatt Journal: J Clin Epidemiol Date: 2013-04-06 Impact factor: 6.437
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Authors: Benjamin Djulbegovic; Thomas A Trikalinos; John Roback; Ren Chen; Gordon Guyatt Journal: BMC Health Serv Res Date: 2009-07-21 Impact factor: 2.655
Authors: Benjamin Djulbegovic; Muhammad Muneeb Ahmed; Iztok Hozo; Despina Koletsi; Lars Hemkens; Amy Price; Rachel Riera; Paulo Nadanovsky; Ana Paula Pires Dos Santos; Daniela Melo; Ranjan Pathak; Rafael Leite Pacheco; Luis Eduardo Fontes; Enderson Miranda; David Nunan Journal: J Eval Clin Pract Date: 2022-01-28 Impact factor: 2.336