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Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. The GRADE approach to developing recommendations

Identifieur interne : 006A68 ( Main/Exploration ); précédent : 006A67; suivant : 006A69

Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. The GRADE approach to developing recommendations

Auteurs : J. L. Brozek [Canada] ; E. A. Akl [Canada, États-Unis] ; E. Compalati [Italie] ; J. Kreis [États-Unis] ; L. Terracciano [Italie] ; A. Fiocchi [Italie] ; E. Ueffing [Canada] ; J. Andrews [États-Unis] ; P. Alonso-Coello [Espagne] ; J. J. Meerpohl [Allemagne] ; D. M. Lang [États-Unis] ; R. Jaeschke [Canada] ; J. W. Williams Jr [États-Unis] ; B. Phillips [Royaume-Uni] ; A. Lethaby [Nouvelle-Zélande] ; P. Bossuyt [Pays-Bas] ; P. Glasziou [Royaume-Uni] ; M. Helfand [États-Unis] ; J. Watine [France] ; M. Afilalo [Canada] ; V. Welch [Canada] ; A. Montedori [Italie] ; I. Abraha [Italie] ; A. R. Horvath [Australie] ; J. Bousquet [France] ; G. H. Guyatt [Canada] ; H. J. Schünemann [Canada]

Source :

RBID : Pascal:11-0227184

Descripteurs français

English descriptors

Abstract

This is the third and last article in the series about the Grading of Recommendations Assessment. Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients' values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients' values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.


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<s1>Department of Obstetrics & Gynecology and Evidence-Based Practice Center, Vanderbilt University</s1>
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<settlement type="city">Barcelone</settlement>
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<author>
<name sortKey="Meerpohl, J J" sort="Meerpohl, J J" uniqKey="Meerpohl J" first="J. J." last="Meerpohl">J. J. Meerpohl</name>
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<inist:fA14 i1="09">
<s1>German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg</s1>
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<country>Allemagne</country>
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<region type="land" nuts="1">Bade-Wurtemberg</region>
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</affiliation>
<affiliation wicri:level="3">
<inist:fA14 i1="10">
<s1>Pediatric Hematology & Oncology, Center for Pediatrics and Adolescent Medicine, University Medical Center Freiburg</s1>
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<s3>DEU</s3>
<sZ>10 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Fribourg-en-Brisgau</region>
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</affiliation>
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<name sortKey="Lang, D M" sort="Lang, D M" uniqKey="Lang D" first="D. M." last="Lang">D. M. Lang</name>
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<s1>Allergy/Immunology Section, Respiratory Institute, Cleveland Clinic</s1>
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</inist:fA14>
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<wicri:noRegion>Cleveland, OH</wicri:noRegion>
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<name sortKey="Jaeschke, R" sort="Jaeschke, R" uniqKey="Jaeschke R" first="R." last="Jaeschke">R. Jaeschke</name>
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<s1>Departments of Clinical Epidemiology & Biostatistics and Medicine, McMaster University</s1>
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<settlement type="city">Hamilton (Ontario)</settlement>
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<orgName type="university">Université McMaster</orgName>
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<name sortKey="Williams Jr, J W" sort="Williams Jr, J W" uniqKey="Williams Jr J" first="J. W." last="Williams Jr">J. W. Williams Jr</name>
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<s1>Department of Internal Medicine and Psychiatry, Duke University and Durham VA Medical Center</s1>
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</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Durham, NC</wicri:noRegion>
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</author>
<author>
<name sortKey="Phillips, B" sort="Phillips, B" uniqKey="Phillips B" first="B." last="Phillips">B. Phillips</name>
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</inist:fA14>
<country>Royaume-Uni</country>
<wicri:noRegion>York</wicri:noRegion>
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<name sortKey="Lethaby, A" sort="Lethaby, A" uniqKey="Lethaby A" first="A." last="Lethaby">A. Lethaby</name>
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<inist:fA14 i1="14">
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<sZ>15 aut.</sZ>
</inist:fA14>
<country>Nouvelle-Zélande</country>
<wicri:noRegion>Auckland</wicri:noRegion>
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</author>
<author>
<name sortKey="Bossuyt, P" sort="Bossuyt, P" uniqKey="Bossuyt P" first="P." last="Bossuyt">P. Bossuyt</name>
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<inist:fA14 i1="15">
<s1>Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam</s1>
<s2>Amsterdam</s2>
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<sZ>16 aut.</sZ>
</inist:fA14>
<country>Pays-Bas</country>
<placeName>
<settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
<settlement type="city">Amsterdam</settlement>
</placeName>
<orgName type="university">Université d'Amsterdam</orgName>
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<author>
<name sortKey="Glasziou, P" sort="Glasziou, P" uniqKey="Glasziou P" first="P." last="Glasziou">P. Glasziou</name>
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<inist:fA14 i1="16">
<s1>Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<placeName>
<settlement type="city">Oxford</settlement>
<region type="country">Angleterre</region>
<region type="comté" nuts="2">Oxfordshire</region>
<settlement type="city">Oxford</settlement>
</placeName>
<orgName type="university">Université d'Oxford</orgName>
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<author>
<name sortKey="Helfand, M" sort="Helfand, M" uniqKey="Helfand M" first="M." last="Helfand">M. Helfand</name>
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<inist:fA14 i1="17">
<s1>Portland Veterans Administration Medical Center and Department of Medicine, Oregon Health & Science University</s1>
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<sZ>18 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Portland, OR</wicri:noRegion>
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<author>
<name sortKey="Watine, J" sort="Watine, J" uniqKey="Watine J" first="J." last="Watine">J. Watine</name>
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<inist:fA14 i1="18">
<s1>Laboratoire de biologie polyvalente, Hôpital de Rodez</s1>
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<sZ>19 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName>
<region type="region">Occitanie (région administrative)</region>
<region type="old region">Midi-Pyrénées</region>
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<name sortKey="Afilalo, M" sort="Afilalo, M" uniqKey="Afilalo M" first="M." last="Afilalo">M. Afilalo</name>
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<s1>Jewish General Hospital, McGill University</s1>
<s2>Montreal, QC</s2>
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<sZ>20 aut.</sZ>
</inist:fA14>
<country>Canada</country>
<placeName>
<settlement type="city">Montréal</settlement>
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<orgName type="university">Université McGill</orgName>
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<name sortKey="Welch, V" sort="Welch, V" uniqKey="Welch V" first="V." last="Welch">V. Welch</name>
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<s1>Centre for Global Health, Institute of Population Health, University of Ottawa</s1>
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<sZ>21 aut.</sZ>
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<country>Canada</country>
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<s1>Office of Regional Health Planning, Regional Health Authority of Umbria</s1>
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<country>Italie</country>
<wicri:noRegion>Perugia</wicri:noRegion>
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<s1>Office of Regional Health Planning, Regional Health Authority of Umbria</s1>
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<sZ>22 aut.</sZ>
<sZ>23 aut.</sZ>
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<country>Italie</country>
<wicri:noRegion>Perugia</wicri:noRegion>
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<name sortKey="Horvath, A R" sort="Horvath, A R" uniqKey="Horvath A" first="A. R." last="Horvath">A. R. Horvath</name>
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<s1>Screening and Test Evaluation Program, School of Public Health, University of Sydney and SEALS Department of Clinical Chemistry, Prince of Wales Hospital</s1>
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<s3>AUS</s3>
<sZ>24 aut.</sZ>
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<country>Australie</country>
<wicri:noRegion>Sydney, NSW</wicri:noRegion>
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<author>
<name sortKey="Bousquet, J" sort="Bousquet, J" uniqKey="Bousquet J" first="J." last="Bousquet">J. Bousquet</name>
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<sZ>25 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName>
<region type="region">Occitanie (région administrative)</region>
<region type="old region">Languedoc-Roussillon</region>
<settlement type="city">Montpellier</settlement>
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<s1>INSERM U1018</s1>
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<sZ>25 aut.</sZ>
</inist:fA14>
<country>France</country>
<wicri:noRegion>Villejuif</wicri:noRegion>
<wicri:noRegion>INSERM U1018</wicri:noRegion>
<wicri:noRegion>INSERM U1018</wicri:noRegion>
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<name sortKey="Guyatt, G H" sort="Guyatt, G H" uniqKey="Guyatt G" first="G. H." last="Guyatt">G. H. Guyatt</name>
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<s1>Departments of Clinical Epidemiology & Biostatistics and Medicine, McMaster University</s1>
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<country>Canada</country>
<placeName>
<settlement type="city">Hamilton (Ontario)</settlement>
<region type="state">Ontario</region>
</placeName>
<orgName type="university">Université McMaster</orgName>
</affiliation>
</author>
<author>
<name sortKey="Schunemann, H J" sort="Schunemann, H J" uniqKey="Schunemann H" first="H. J." last="Schünemann">H. J. Schünemann</name>
<affiliation wicri:level="4">
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<s1>Departments of Clinical Epidemiology & Biostatistics and Medicine, McMaster University</s1>
<s2>Hamilton, ON</s2>
<s3>CAN</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
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<country>Canada</country>
<placeName>
<settlement type="city">Hamilton (Ontario)</settlement>
<region type="state">Ontario</region>
</placeName>
<orgName type="university">Université McMaster</orgName>
</affiliation>
</author>
</analytic>
<series>
<title level="j" type="main">Allergy : (Copenhagen)</title>
<title level="j" type="abbreviated">Allergy : (Cph.)</title>
<idno type="ISSN">0105-4538</idno>
<imprint>
<date when="2011">2011</date>
</imprint>
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<seriesStmt>
<title level="j" type="main">Allergy : (Copenhagen)</title>
<title level="j" type="abbreviated">Allergy : (Cph.)</title>
<idno type="ISSN">0105-4538</idno>
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</fileDesc>
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<textClass>
<keywords scheme="KwdEn" xml:lang="en">
<term>Dermatology</term>
<term>Evidence-based medicine</term>
<term>Histological grading</term>
<term>Immunology</term>
<term>Immunopathology</term>
<term>Professional practice</term>
<term>Quality</term>
<term>Recommendation</term>
<term>Strength</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr">
<term>Grade histologique</term>
<term>Qualité</term>
<term>Résistance mécanique</term>
<term>Recommandation</term>
<term>Pratique professionnelle</term>
<term>Médecine factuelle</term>
<term>Dermatologie</term>
<term>Immunologie</term>
<term>Immunopathologie</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr">
<term>Recommandation</term>
<term>Immunologie</term>
</keywords>
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<front>
<div type="abstract" xml:lang="en">This is the third and last article in the series about the Grading of Recommendations Assessment. Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients' values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients' values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.</div>
</front>
</TEI>
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<li>Allemagne</li>
<li>Australie</li>
<li>Canada</li>
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<li>Nouvelle-Zélande</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
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<li>Angleterre</li>
<li>Bade-Wurtemberg</li>
<li>Catalogne</li>
<li>District de Fribourg-en-Brisgau</li>
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<li>Languedoc-Roussillon</li>
<li>Lombardie</li>
<li>Midi-Pyrénées</li>
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<li>Montréal</li>
<li>Oxford</li>
<li>Rodez</li>
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<li>Université McGill</li>
<li>Université McMaster</li>
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<name sortKey="Brozek, J L" sort="Brozek, J L" uniqKey="Brozek J" first="J. L." last="Brozek">J. L. Brozek</name>
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