Structured decision-making drives guidelines panels' recommendations "for" but not "against" health interventions.
Clinical recommendations
Decision theory
Evidence based medicine
GRADE
Group decision making
Practice guidelines
Journal
Journal of clinical epidemiology
ISSN: 1878-5921
Titre abrégé: J Clin Epidemiol
Pays: United States
ID NLM: 8801383
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
08
07
2018
revised:
24
01
2019
accepted:
07
02
2019
pubmed:
20
2
2019
medline:
19
5
2020
entrez:
20
2
2019
Statut:
ppublish
Résumé
The determinants of guideline panels' recommendations remain uncertain. The objective of this study was to investigate factors considered by members of 8 panels convened by the American Society of Hematology (ASH) to develop guidelines using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Web-based survey of the participants in the ASH guidelines panels. two-level hierarchical, random-effect, multivariable regression analysis to explore the relation between GRADE and non-GRADE factors and strength of recommendations (SOR). In the primary analysis, certainty in evidence [OR = 1.83; (95CI% 1.45-2.31)], balance of benefits and harms [OR = 1.49 (95CI% 1.30-1.69)] and variability in patients' values and preferences [OR = 1.47 (95CI% 1.15-1.88)] proved the strongest predictors of SOR. In a secondary analysis, certainty of evidence was associated with a strong recommendation [OR = 3.60 (95% CI 2.16-6.00)] when panel members recommended "for" interventions but not when they made recommendations "against" interventions [OR = 0.98 (95%CI: 0.57-1.8)] consistent with "yes" bias. Agreement between individual members and the group in rating SOR varied (kappa ranged from -0.01 to 0.64). GRADE's conceptual framework proved, in general, to be highly associated with SOR. Failure of certainty of evidence to be associated with SOR against an intervention, suggest the need for improvements in the process.
Sections du résumé
BACKGROUND AND OBJECTIVES
The determinants of guideline panels' recommendations remain uncertain. The objective of this study was to investigate factors considered by members of 8 panels convened by the American Society of Hematology (ASH) to develop guidelines using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
STUDY DESIGN AND SETTING
Web-based survey of the participants in the ASH guidelines panels.
ANALYSIS
two-level hierarchical, random-effect, multivariable regression analysis to explore the relation between GRADE and non-GRADE factors and strength of recommendations (SOR).
RESULTS
In the primary analysis, certainty in evidence [OR = 1.83; (95CI% 1.45-2.31)], balance of benefits and harms [OR = 1.49 (95CI% 1.30-1.69)] and variability in patients' values and preferences [OR = 1.47 (95CI% 1.15-1.88)] proved the strongest predictors of SOR. In a secondary analysis, certainty of evidence was associated with a strong recommendation [OR = 3.60 (95% CI 2.16-6.00)] when panel members recommended "for" interventions but not when they made recommendations "against" interventions [OR = 0.98 (95%CI: 0.57-1.8)] consistent with "yes" bias. Agreement between individual members and the group in rating SOR varied (kappa ranged from -0.01 to 0.64).
CONCLUSION
GRADE's conceptual framework proved, in general, to be highly associated with SOR. Failure of certainty of evidence to be associated with SOR against an intervention, suggest the need for improvements in the process.
Identifiants
pubmed: 30779950
pii: S0895-4356(18)30616-4
doi: 10.1016/j.jclinepi.2019.02.009
pmc: PMC7268742
mid: NIHMS1594305
pii:
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
23-33Subventions
Organisme : AHRQ HHS
ID : R01 HS024917
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
J Pers Soc Psychol. 1999 Jun;76(6):972-87
pubmed: 10402681
J Oncol Pract. 2014 May;10(3):200-2
pubmed: 24839282
BMC Health Serv Res. 2009 Jul 21;9:120
pubmed: 19622148
BMJ. 2011 Oct 17;343:d6386
pubmed: 22006953
J Clin Epidemiol. 2013 Jul;66(7):726-35
pubmed: 23570745
Ann Intern Med. 2009 Feb 3;150(3):199-205
pubmed: 19189910
N Engl J Med. 2015 Sep 24;373(13):1187-9
pubmed: 26398068
Am J Med Qual. 2014 Jan-Feb;29(1):53-60
pubmed: 23550214
Psychol Bull. 2002 Nov;128(6):978-96
pubmed: 12405140
BMJ. 2016 Jun 28;353:i2016
pubmed: 27353417
BMJ. 2008 Apr 26;336(7650):924-6
pubmed: 18436948
Ann Intern Med. 2011 Jun 7;154(11):752-7
pubmed: 21646558
J Clin Epidemiol. 2018 Dec;104:103-112
pubmed: 30253221
Psychol Sci. 2006 May;17(5):428-33
pubmed: 16683931
Med Decis Making. 2014 Jul;34(5):627-37
pubmed: 24722474
Am Fam Physician. 2004 Feb 1;69(3):548-56
pubmed: 14971837
BMJ. 2001 Aug 11;323(7308):334-6
pubmed: 11498496
Cognition. 2001 Aug;81(1):93-103; discussion 105-11
pubmed: 11525483
Chest. 2013 Aug;144(2):381-389
pubmed: 23918106
Psychol Bull. 2016 Mar;142(3):260-90
pubmed: 26436538
PLoS One. 2015 Aug 04;10(8):e0134038
pubmed: 26241650
J Clin Epidemiol. 2016 Jul;75:115-8
pubmed: 26845745
J Pers. 1962 Mar;30:29-50
pubmed: 13874381
Q J Exp Psychol (Hove). 2010 May;63(5):892-909
pubmed: 19728225
JAMA. 2013 Dec 18;310(23):2501-2
pubmed: 24310916
Mem Cognit. 2006 Apr;34(3):619-32
pubmed: 16933770
Exp Psychol. 2006;53(2):123-31
pubmed: 16909937
BMJ. 2016 Jun 30;353:i2089
pubmed: 27365494
Cognition. 2014 Apr;131(1):75-91
pubmed: 24462712
J Clin Epidemiol. 2015 Jul;68(7):727-32
pubmed: 25766057
Lancet. 2017 Jul 22;390(10092):415-423
pubmed: 28215660
BMJ. 2008 May 10;336(7652):1049-51
pubmed: 18467413