A guide for health professionals to interpret and use recommendations in guidelines developed with the GRADE approach

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• 作者：Ignacio Neumann^a ; ^b ; ^{ignacio.neumann@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Nancy Santesso^a ; Elie A. Akl^a ; ^c ; David M. Rind^d ; ^e ; Per Olav Vandvik^f ; Pablo Alonso-Coello^g ; Thomas Agoritsas^a ; ^h ; Reem A. Mustafa^a ; ⁱ ; Paul Elias Alexander^a ; Holger Schü ; nemann^a ; Gordon H. Guyatt^a
• 关键词：Clinical practice guidelines ; GRADE ; Decision making ; Evidence-based practice ; Recommendations ; Medical education
• 刊名：Journal of Clinical Epidemiology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：72
• 期：Complete
• 页码：45-55
• 全文大小：231 K

文摘

An increasing number of organizations worldwide are using new and improved standards for developing trustworthy clinical guidelines. One of such approaches, developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group, offers systematic and transparent guidance in moving from evidence to recommendations. The GRADE strategy concentrates on four factors: the balance between benefits and harms, the certainty of the evidence, values and preferences, and resource considerations. However, it also considers issues around feasibility, equity, and acceptability of recommendations. GRADE distinguishes two types of recommendations: strong and weak. Strong recommendations reflect a clear preference for one alternative and should apply to all or almost all patients, obviating the need for a careful review of the evidence with each patient. Weak recommendations are appropriate when there is a close balance between desirable and undesirable consequences of alternative management strategies, uncertainty regarding the effects of the alternatives, uncertainty or variability in patients' values and preferences, or questionable cost-effectiveness. Weak recommendations usually require accessing the underlying evidence and a shared decision-making approach. Clinicians using GRADE recommendations should understand the meaning of the strength of the recommendation, be able to critically appraise the recommendation, and apply trustworthy recommendations according to their strength.