Evidence map›Paper›PMID 30253221›Full record

ArticleJournal of clinical epidemiology2018

Evidence to Decision framework provides a structured "roadmap" for making GRADE guidelines recommendations.

Shelly-Anne Li, Paul E Alexander, Tea Reljic, Adam Cuker, Robby Nieuwlaat, Wojtek Wiercioch, Gordon Guyatt, Holger J Schünemann, Benjamin Djulbegovic

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical epidemiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
  3. Guideline
  4. Guideline
  5. Use of Iontophoresis with Corticosteroid in Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2023
    Pooled it
  6. Guideline
  7. Article
  8. Article
  9. Article
  10. Article
  11. Review
  12. Users' experience of frameworks to support evidence-informed decision-making in public health: a scoping review.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025
    Article
  13. Frameworks to support evidence-informed decision-making in public health and infectious disease prevention and control: a scoping review.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025
    Article
  14. Observational
  15. Article
  16. Review
  17. Article
  18. Article
  19. Article
  20. An updated practice guideline for death determination: one giant leap for the field led by Canada.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Shelly-Anne LiLawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada. Electronic address: shellyanne.li@mail.utoronto.ca.
Paul E AlexanderDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada.
Tea ReljicComparative Effectiveness Research Program, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Avenue, MDT 1212, Tampa, FL 33612, USA.
Adam CukerDepartment of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Robby NieuwlaatDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada.
Wojtek WierciochDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada.
Gordon GuyattDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada.
Holger J SchünemannDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada.
Benjamin DjulbegovicDepartment of Supportive Care Medicine, Department of Hematology, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.

Funding

PA-20-070 "Development of evidence-based decision support for the management of COVID19"R01HS024917 · AHRQ · UNIVERSITY OF SOUTH FLORIDA · PI DJULBEGOVIC, BENJAMIN · 2016 to 2021
$2.3M
AHRQ HHS R01 HS024917
6 · The paper itself

Abstract

objectivesIt is unclear how guidelines panelists discuss and consider factors (criteria) that are formally and not formally included in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. To describe the use of decision criteria, we explored how panelists adhered to GRADE criteria and sought to identify any emerging non-GRADE criteria when the panelists used the Evidence to Decision (EtD) framework as part of GRADE application. STUDY DESIGN AND

settingWe used conventional and summative qualitative analyses to identify themes emerging from face-to-face, panel meeting discussions. Forty-eight members from 12 countries participated in the development of five guidelines for the management of venous thromboembolism by the American Society of Hematology.

resultsTen themes corresponded to the GRADE approach and represented all panel discussions. Over half (53%) of the total panel discussions concerned the use of research evidence. When evidence was considered sufficient and clear, the decision-making process proved rapid.

conclusionThe GRADE EtD framework provides structure to guidelines panel meetings, and ensures that the panelists consider all established formal GRADE criteria as they decide on the recommendation text, strength, and direction (for or against an intervention). This is the first study assessing the use of GRADE's EtD framework during real-time guidelines development using panel discussions. Given the widespread use of GRADE, this study provides important information for practice recommendations generated when guidelines panels explicitly follow, in a transparent and systematic manner, the structured GRADE EtD framework. By recognizing the extent to which panels discuss and consider GRADE and other (non-GRADE) criteria for producing guideline recommendations, we are one step closer to understanding the decision-making process in panels that use a structured framework such as the GRADE EtD framework.

Indexed as

Decision MakingEvaluation Studies as TopicEvidence-Based MedicineGRADE ApproachGroup ProcessesGuideline AdherenceGuidelines as TopicHumansPractice Guidelines as TopicClinical practice guidelinesDecision-makingEpidemiologyEvidence to Decision frameworkGRADEgroup processing

Identifiers

PMID30253221
PMCPMC7275375

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.