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Implementation Science

, 11:93

First Online: 15 July 2016Received: 21 December 2015Accepted: 20 June 2016DOI: 10.1186-s13012-016-0462-y

Cite this article as: Neumann, I., Brignardello-Petersen, R., Wiercioch, W. et al. Implementation Sci 2015 11: 93. doi:10.1186-s13012-016-0462-y


BackgroundJudgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework EtD offers a transparent way to record and report guideline developers’ judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels.

MethodsFollowing the guideline panel meetings, we asked methodologists participating in the panel to provide feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback collected from the rest of the panel. Two investigators independently summarized the responses and jointly interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results and provide further input to improve the structure of the EtDs iteratively.

ResultsThe EtD framework was well received, and the comments were generally positive. Methodologists felt that in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in an explicit and transparent way. However, some sections e.g. -values and preferences- and -balance between benefits and harms- required further development and clarification that were considered in the current version of the EtD framework.

ConclusionsThe use of an EtD framework in guideline development offers a structured and explicit way to record and report the judgments and discussion of guideline panels during the formulation of recommendations. In addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in research.

KeywordsClinical practice guidelines GRADE Evidence to decisions framework GRADEpro Recommendations Electronic supplementary materialThe online version of this article doi:10.1186-s13012-016-0462-y contains supplementary material, which is available to authorized users.

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