Experiences and challenges faced by systematic review authors in using the GRADE approach: a qualitative study

This study aimed to gather feedback from systematic review authors on the use of the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach and to explore potential barriers to its implementation.

A qualitative study was conducted using semistructured interviews with principal investigators who are experienced in systematic review methodology and the use of the GRADE approach, about their experiences and challenges in using GRADE. Before the interview, all participants completed a structured questionnaire about their experience with GRADE and in conducting systematic reviews.

Eleven of 41 invited experts participated in the study, offering detailed insights into the experiences and challenges of using GRADE. While the participants appreciated GRADE's structured approach to evaluating evidence, they highlighted several challenges, including its complexity, perceived subjectivity in grading, and the need for more practical guidance and examples. Barriers to GRADE use included difficulties in applying specific domains (primarily imprecision and indirectness), lack of adequate training, time constraints, motivational and attitudinal barriers, and financial limitations. The participants emphasized the importance of formal education, improved guidelines, and greater journal support to encourage GRADE adoption. They expressed mixed opinions on whether GRADE should be mandatory in all systematic reviews. While participants agreed on the need to promote GRADE, concerns were raised about its universal implementation potentially hindering research flexibility and innovation.

To enhance the use of GRADE, the research community should focus on improving training, developing more efficient tools, and striking a balance between standardization and scientific flexibility.

GRADE is a tool to check how reliable and good the evidence is in research. This study looked at the challenges researchers face when using GRADE and their opinions on improving it. Researchers found GRADE valuable because it is well structured but noted it has issues such as being too complex, subjective, and needing clearer instructions. Other problems were the lack of training, not enough time and money, and low motivation. Researchers said that better training, clearer guidelines, and support from journals are needed to make GRADE easier to use.