scholarly journals Moving From Evidence To Decisions in Guidelines: An Analysis of Guidance Documents

Author(s):  
Jose F Meneses-Echavez ◽  
Julia Bidonde ◽  
Juan Jose Yepes-Nuñez ◽  
Tina Poklepović Peričić ◽  
Livia Puljak ◽  
...  

Abstract Background The process of moving from evidence to decisions (EtD) represents a cornerstone within guideline development methods. Little is known about the processes used by organizations in charge of guideline development and what criteria they consider when formulating recommendations. Objective To identify and describe the processes suggested for the formulation of healthcare recommendations in health care guidelines available in guidance documents. Methods We searched in spring 2020 the Guidelines International Network (G-I-N) website, MEDLINE, and The Cochrane Methodology Register to retrieve guidance documents published in the last decade by organizations dedicated to guideline development. Pairs of researchers independently selected and extracted data about the characteristics of the guidance document, including explicit or implicit recommendation-related criteria and processes considered, as well as the use of frameworks. We conducted both descriptive and bivariate analyses. Results We included 68 guidance documents, published mostly by scientific societies (58%). Most of the organizations reported a system for grading the strength of recommendations (88%), half of them being the GRADE approach. Two out of three guidance documents (66%) proposed the use of a framework to guide the EtD process. We identified 14 recommendation-related criteria. The GRADE Evidence to Decision (GRADE-EtD) framework was the most often reported framework (19 organizations, 42%), whereas 20 organizations (44%) proposed their own multi-criteria frameworks. Using any EtD framework was related with a more comprehensive set of recommendation-related criteria compared to no framework, especially for criteria like values, equity, and acceptability. A similar association was observed between the GRADE-EtD framework and either no framework or another EtD frameworks. Conclusion The use of systematic and structured processes for moving from evidence to decisions is still limited among international organizations. The use of EtD frameworks facilitates the inclusion of relevant recommendation criteria. Among the structured frameworks, the GRADE-EtD framework offers the most comprehensive perspective for evidence-informed decision-making processes. More complete and detailed reporting in the guidance documents is warranted.

2014 ◽  
Vol 94 (11) ◽  
pp. 1652-1659 ◽  
Author(s):  
Tricia M. Austin ◽  
Randy R. Richter ◽  
Chris A. Sebelski

BackgroundPractice guidelines (guidelines) have an increasing role in health care delivery and are being published more frequently. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an approach for guideline development. The GRADE approach has been adopted by multiple national and international organizations producing guidelines related to physical therapist care.ObjectiveThe purpose of this article is to introduce physical therapists to the GRADE approach for guideline development.ResultsGRADE provides a consistent approach for guideline development and transparency in the communication of how the guidelines were developed and how the recommendations were reached, leading to informed choices by patients, clinicians, and policy makers in health care. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. Both the direction (for or against) and the strength (weak or strong) of the recommendation are considered. For determining the strength of the recommendation, GRADE takes into account the quality of evidence, the balance of benefit and harm, uncertainty about or variability in patients' values and preferences, and uncertainty about whether the intervention is a wise use of resources.LimitationsThe GRADE approach has been used primarily with interventions and clinical questions and less often with questions related to diagnosis and prognosis.ConclusionsThe frequency of publication of guidelines is increasing. To make informed choices in the health care system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices.


2020 ◽  
Vol 5 (Suppl 1) ◽  
pp. e002060
Author(s):  
Samira Aboubaker ◽  
Egmond Samir Evers ◽  
Loulou Kobeissi ◽  
Lauren Francis ◽  
Robinah Najjemba ◽  
...  

BackgroundSignificant global gains in sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) will be difficult unless conflict settings are adequately addressed. We aimed to determine the amount, scope and quality of publically available guidance documents, to characterise the process by which agencies develop their guidance and to identify gaps in guidance on SRMNCAH&N promotion in conflicts.MethodsWe identified guidance documents published between 2008 and 2018 through English-language Internet sites of humanitarian response organisations, reviewed them for their scope and assessed their quality with the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) tool. Additionally, we interviewed 22 key informants on guidance development, dissemination processes, perceived guidance gaps and applicability.FindingsWe identified 105 conflict-relevant guidance documents from 75 organisations. Of these, nine were specific to conflicts, others were applicable also to other humanitarian settings. Fifteen documents were technical normative guidelines, others were operational guides (67), descriptive documents (21) or advice on legal, human rights or ethics questions (2). Nutrition was the most addressed health topic, followed by communicable diseases and violence. The documents rated high quality in their ‘scope and purpose’ and ‘clarity of presentation’ and low for ‘rigour of development’ and ‘editorial independence’. Key informants reported end user need as the primary driver for guideline development and WHO technical guidelines as their main evidence base. Insufficient local contextualisation, lack of inter-agency coordination and lack of systematic implementation were considered problems in guideline development. Several guidance gaps were noted, including abortion care, newborn care, early child development, mental health, adolescent health beyond sexual and reproductive health and non-communicable diseases.InterpretationOrganisations are motivated and actively producing guidance for SRMNCAH&N promotion in humanitarian settings, but few documents address conflicts specifically and there are important guidance gaps. Improved inter-organisation collaboration for guidance on SRMNCAH&N promotion in conflicts and other humanitarian settings is needed.


2020 ◽  
Vol 30 (4) ◽  
pp. 548-562 ◽  
Author(s):  
Susan Webb Yackee

Abstract I test the proposition that interest groups achieve greater policy success when they lobby during the agency guidance document development process as opposed to the notice and comment process. Policymaking via guidance documents often receives lower levels of public attention, which provides greater flexibility to accommodate lobbying requests. I analyze the hypothesis during the creation of 41 rules by one US government agency—20 of which were promulgated using the notice and comment process and 21 via the guidance document process. I measure regulatory policy change using a content analysis of government documents and lobbying texts, and I also incorporate a telephone survey of interest groups who lobbied on these same rules. I find that interest groups perceive—and achieve—greater policy success when lobbying during the agency guidance process. The results yield new insights into the relationship between lobbying and regulatory policymaking.


2019 ◽  
Vol 46 (04) ◽  
pp. 398-409 ◽  
Author(s):  
Robert C. Gosselin ◽  
Dorothy Adcock ◽  
Akbar Dorgalaleh ◽  
Emmanuel J. Favaloro ◽  
Giuseppe Lippi ◽  
...  

AbstractThis guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH), the aim of which is to provide hemostasis-related guidance documents for clinical laboratories. The current ICSH document was developed by an ad hoc committee, comprising an international collection of both clinical and laboratory experts. The purpose of this ICSH document is to provide laboratory guidance for (1) identifying hemostasis (coagulation) tests that have potential patient risk based on analysis, test result, and patient presentations, (2) critical result thresholds, (3) acceptable reporting and documenting mechanisms, and (4) developing laboratory policies. The basis for these recommendations was derived from published data, expert opinion, and good laboratory practice. The committee realizes that regional and local regulations, institutional stakeholders (e.g., physicians, laboratory personnel, hospital managers), and patient types (e.g., adults, pediatric, surgical) will be additional confounders for a given laboratory in generating a critical test list, critical value thresholds, and policy. Nevertheless, we expect this guidance document will be helpful as a framework for local practice.


Author(s):  
Ehlers Peter

This chapter focuses on the work of the Intergovernmental Oceanographic Commission (IOC), a separate unit of UNESCO, in respect to global ocean governance. The functions of IOC are part of the system of ocean governance, based on 1982 United Nations Convention on the Law of the Sea (UNCLOS). Its purpose is to promote international cooperation and to coordinate programmes in research, services and capacity building, in order to learn more about the nature and resources of the ocean and coastal areas and to apply that knowledge for the improvement of management, sustainable development, the protection of the marine environment, and the decision-making processes of its Member States. The chapter first provides an overview of IOC’s purpose and organisational structure, its collaboration with international organizations with regard to ocean governance, and its ocean governance-related activities before discussing the ways in which it contributes to capacity building and enhancing ocean governance.


2014 ◽  
Vol 20 (10) ◽  
pp. 1282-1287 ◽  
Author(s):  
Pavel Balabanov ◽  
Manuel Haas ◽  
Andre Elferink ◽  
Serge Bakchine ◽  
Karl Broich

Improving and facilitating the process of making new drugs available to patients with multiple sclerosis (MS) requires cooperation among the regulators and other stakeholders. This cooperation will also positively contribute towards developing guidelines of the highest quality in medical, regulatory and scientific aspects. This would be beneficial both in areas that require further guideline development, but also in fields where existing guidance should be adapted to take into account evolution in science. Considering the input from all stakeholders, the European Medicines Agency confirmed its intention to update the relevant guideline and apply a flexible approach towards new drug development strategies in MS. This article is the first official position from the EU regulators, presenting the main changes to be expected in the guidance document.


2013 ◽  
Vol 7 (1) ◽  
Author(s):  
Joel J Gagnier ◽  
◽  
Gunver Kienle ◽  
Douglas G Altman ◽  
David Moher ◽  
...  

1998 ◽  
Vol 2 (3) ◽  
Author(s):  
Murphy ◽  
Black ◽  
Lamping ◽  
McKee ◽  
Sanderson ◽  
...  

Author(s):  
Barros Ana Sofia

The present case addresses the responsibility of states for their own conduct performed in the framework of international organizations. The matter at stake concerned the responsibility of Greece for its objection to FYROM’s candidacy for membership in NATO, which eventually led to latter’s decision to refuse FYROM’s admission. Contrary to Greece’s contention that the decision had been taken by NATO as a whole, and that it was thus solely attributable to it, the ICJ lifted the institutional veil and rather concentrated on the legality of the individual conduct of Greece. In this decision, the Court confirmed that member state participation in institutional decision-making processes can, in its own right, constitute legally relevant conduct against which state compliance with earlier international law obligations may be judged.


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