While many clinical practice guidelines that use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach have ample published evidence to support their recommendations, certain situations (e.g. rare, rapidly emerging, or understudied diseases) may be limiting. As a result, it is common for guideline developers to seek out indirect evidence from other areas to fill in these evidence gaps. The GRADE evidence-to-decision (EtD) framework, which offers a structured and transparent development process for guidelines, includes additional research evidence domains (e.g. feasibility, acceptability, equity) for panels to consider in their decision-making process. This confluence of both considerations of indirect information and increasing literature domain sources to draw from when making decisions weighs on the simplicity of literature presentation. Herein, firstly, we described an example of specific decision-rules for including indirect evidence and the implications of the rules for presenting results to decision-makers. Secondly, we provided a comprehensive overview of how guideline developers currently report economic information across GRADE evidence-to-decision frameworks. Lastly, we ranked the most important study characteristics suggested in the literature by economists to consider as decision-rules when assessing indirectness (transferability) of economic evaluations chosen as research evidence in a GRADE guideline. We conclude that developers, with the help of their panels, should work to establish and report clear decision-rules and the rationale for indirect evidence that they select for their clinical practice guidelines. This has the potential to simplify the presentation of indirect evidence for panels and developers, as well as, to reduce decision-making confusion, time demands and guideline funder costs. / Thesis / Candidate in Philosophy / While many clinical practice guidelines have ample published evidence to support their recommendations, certain situations (e.g. rare, rapidly emerging, or understudied diseases) may be limiting the available literature. As a result, it is common for guideline developers to seek out indirect evidence from other, but related areas, to fill in these evidence gaps. Selection of available indirect evidence may be better than basing decisions on no evidence, in particular in situations of clinical equipoise. However, including all potentially relevant indirect evidence may represent an overuse of evidence. Indirect evidence refers to information sources with related populations, interventions, outcomes or comparisons, which could reasonably be extrapolated; but, are not entirely specific to the research topic at hand. This confluence of both indirect information considerations and desire by many for increasing literature sources to draw from weighs on the simplicity of an overall summary of literature presented during a guideline recommendation decision-making process. Herein, firstly, we described an example of explicit decision-rules for including indirect evidence that were specific and the implications of the rules for presenting results to decision-makers. Secondly, we provided a comprehensive overview of how guideline developers currently report economic information across guideline frameworks, in particular with respect to indirectness. Lastly, we described the most important study characteristics suggested by economists to consider as decision-rules when assessing economic evaluations for use as research evidence in a guideline.
This work presents important concepts for guideline developers to consider when choosing indirect evidence sources in their clinical practice guidelines. Our findings have the potential to simplify the presentation of indirect evidence for guideline panels and developers, as well as, to reduce decision-making confusion, time demands and guideline funder costs.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/25986 |
| Date | January 2020 |
| Creators | Riva, John |
| Contributors | Brozek, Jan, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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