Evidence map›Paper›PMID 39787778›Full record

SynthesisEnvironment international2025

Development of a framework to structure decision-making in environmental and occupational health: A systematic review and Delphi study.

Emily Senerth, Paul Whaley, Elie Akl, Brandy Beverly, Pablo Alonso-Coello, Ezza Jalil, Jayati Khattar, Nicole R Palmer, Andrew Rooney, Holger J Schünemann and 3 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Environment international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 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

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. 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

13 authors.

Emily SenerthDepartment of Epidemiology, George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW #2, Washington, DC 20052, USA.
Paul WhaleyEvidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205, USA; Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK. Electronic address: paul@whaleyresearch.uk.
Elie AklAmerican University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
Brandy BeverlyDivision of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC, USA 27709.
Pablo Alonso-CoelloInstitut de Recerca Sant Pau (IR Sant Pau-CIBERESP), Sant Quintí 77-79 08041, Barcelona, Spain; Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, 167 08025, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Ezza JalilCochrane Canada and McMaster GRADE Centres & Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
Jayati KhattarCochrane Canada and McMaster GRADE Centres & Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
Nicole R PalmerCochrane Canada and McMaster GRADE Centres & Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
Andrew RooneyDivision of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC, USA 27709.
Holger J SchünemannCentro Cochrane Iberoamericano, Sant Antoni Maria Claret, 167 08025, Barcelona, Spain.
Kristina A ThayerCenter for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division, Office of Research and Development, US Environmental Protection Agency, Building B (Room 211i), Research Triangle Park, NC, USA 27711.
Katya TsaiounEvidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205, USA.
Rebecca L MorganCochrane Canada and McMaster GRADE Centres & Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA. Electronic address: morganrl@mcmaster.ca.

Funding

Intramural EPA EPA999999
6 · The paper itself

Abstract

backgroundEnvironmental and occupational health (EOH) assessments increasingly utilize systematic review methods and structured frameworks for evaluating evidence about the human health effects of exposures. However, there is no prevailing approach for how to integrate this evidence into decisions or recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision (EtD) frameworks provide a structure to support standardized and transparent consideration of relevant criteria to inform health decisions. This study identifies and synthesizes available EOH decision frameworks and evaluates the applicability and usability of an existing GRADE EtD perspective to advance the development of a tailored EOH EtD framework.

methodsWe performed a systematic review of MEDLINE, EMBASE, and Cochrane Library, and a manual search of gray literature to identify frameworks that inform decision-making about EOH exposures from the years 2011 to 2021. We abstracted and analyzed decision considerations from each framework through narrative synthesis. Next, we conducted a two-round Delphi process, engaging stakeholders from the following perspectives within environmental and occupational health: risk assessment and management, nutrition and food safety, cancer, and socio-economic analysis. Panelists rated the relevance and wording of each consideration on a 7-point Likert scale and provided free-text comments during both phases. Considerations that did not meet predetermined thresholds were excluded.

resultsOut of 5,196 unique references, we identified 22 published reports of EOH decision frameworks. We identified another 16 frameworks in a search of gray literature, totaling 38 source frameworks. We abstracted 560 individual decision considerations from these frameworks, 104 of which may contribute additional information to the guidance, scope, context, or assessment criteria of the GRADE EtD framework. In round 1 of the Delphi study, 50 decision considerations were aggregated or removed, and 9 were aggregated or removed after round 2, for a final total of 47. No new decision considerations were added in either round. We identified several differences between decision criteria that are applied in EOH and the GRADE EtD framework, including vocabulary that is specific to EOH (e.g., toxicity, the precautionary principle), and granularity of the EOH decision considerations (e.g., detailed signaling questions to assess feasibility and resources required). However, this study did not identify any EOH decision criteria that are completely distinct from the GRADE EtD framework.

conclusionsFindings of this mixed-methods study comprise a foundation for a GRADE EtD that is applicable for use in EOH decision-making, with implications for approaches to regulation of environmental and occupational exposures and the formulation of recommendations for interventions to prevent or mitigate undesirable health and other consequences.

Indexed as

Decision MakingEnvironmental HealthOccupational HealthDelphi TechniqueEnvironmental ExposureHumansRisk AssessmentDecision frameworkDecision-makingDelphiEnvironmental healthGRADEOccupational healthSystematic review

Identifiers

PMID39787778
PMCPMC12026343

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.