Assessing the Evidence Series
By Pablo Alonso Coello, MD, PhD
Evidence to Decisions Frameworks
The developed frameworks are based on the GRADE Working Group’s approach for moving from evidence to clinical recommendations5-7. The methodology used was iterative, including review of the research literature, brainstorming, stakeholder feedback, application to recommendations examples, and user testing1. Although the frameworks are similar, there are some differences among them.
Purpose of the frameworks
The EtD frameworks have three sections: the formulation of the question, making an assessment of the research evidence (and additional considerations) supporting each criterion, and drawing conclusions1.
Preparing and using these frameworks
- Treweek S, Oxman AD, Alderson P, Bossuyt P, Brozek J, et al. Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE): Protocol and preliminary results. Implementation Sci 2013, 8:6 doi:10.1186/1748-5908-8-6.
- Alonso-Coello P, Schunemann HJ, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016;353:i2016.
- Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016;353:i2089.
- Schünemann HJ, Mustafa R, Brozek J, Santesso N, Alonso-Coello P, Guyatt G, et al; GRADE Working Group. GRADE Guidelines: 16. GRADE evidence to decision frameworks for tests in clinical practice and public health. J Clin Epidemiol. 2016 Feb 27. pii: S0895-4356(16)00136-0. doi: 10.1016/j.jclinepi.2016.01.032. [Epub ahead of print]
- Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, et al: GRADE Working Group. Going from evidence to recommendations. BMJ 2008; 336:1049-51.
- Andrews J, Guyatt GH, Oxman AD, Alderson P, Dahm P, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 2013 Jan 9. pii: S0895-4356(12)00138-2. doi: 10.1016/j.jclinepi.2012.03.013.
- Andrews J, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 15. Going from evidence to recommendations: determinants of a recommendations direction and strength. J Clin Epidemiol 2013 Apr 6. pii: S0895-4356(13)00054-1. doi: 10.1016/j.jclinepi.2013.02.003.
- GRADEpro handbook
About the author:
Pablo Alonso-Coello is a researcher at the Iberoamerican Cochrane Center (Biomedical Research Institute Sant Pau), in Barcelona. He is a member of the GRADE Guidance Group and is responsible of the Barcelona GRADE center. He is also the Director of the Scientific Committee of GuiaSalud, the organization in charge of coordinating the Spanish National Health System Program of Clinical Guidelines.