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Structured decision-making drives guidelines panels' recommendations "for" but not "against" health interventions
Benjamin Djulbegovic1, Tea Reljic2, Shira Elqayam3
1Department 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.
Journal of Clinical Epidemiology
|February 20, 2019
Summary
The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system factors, including evidence certainty and patient values, strongly predict guideline recommendations. Improvements are needed for recommendations against interventions.
Area of Science:
- Health Policy
- Medical Guidelines
- Evidence-Based Medicine
Background:
- Determining factors influencing guideline panel recommendations is crucial for understanding medical practice.
- The American Society of Hematology (ASH) convened panels to develop guidelines using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
Purpose of the Study:
- To investigate the factors considered by members of ASH guideline panels.
- To explore the relationship between GRADE system factors and non-GRADE factors with the strength of recommendations (SOR).
Main Methods:
- A web-based survey was administered to participants of ASH guideline panels.
- A two-level hierarchical, random-effect, multivariable regression analysis was employed to analyze the data.
Main Results:
- Certainty in evidence, balance of benefits and harms, and patient values/preferences were the strongest predictors of SOR.
- Certainty of evidence predicted strong "for" recommendations but not "against" recommendations, indicating a potential "yes" bias.
- Agreement among panel members on SOR varied significantly.
Conclusions:
- The GRADE conceptual framework is generally associated with SOR.
- The association between certainty of evidence and SOR against interventions suggests a need to refine the guideline development process.
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