Abstract
Objectives
To describe the grading of recommendations assessment, development and evaluation
(GRADE) interactive evidence to decision (EtD) frameworks for tests and test strategies
for clinical, public health, or coverage decisions.
Study Design and Setting
As part of the GRADE Working Group's DECIDE project, we conducted workshops, user
testing with systematic review authors, guideline developers and other decision makers,
and piloted versions of the EtD framework.
Results
EtD frameworks for tests share the structure, explicitness, and transparency of other
EtD frameworks. They require specifying the purpose of the test, linked or related
management, and the key outcomes of concern for different test results and subsequent
management. The EtD criteria address test accuracy and assessments of the certainty
of the additional evidence necessary for decision making. When there is no direct
evidence of test effects on patient-important outcomes, formal or informal modeling
is needed to estimate effects. We describe the EtD criteria based on examples developed
with GRADEpro (www.gradepro.org), GRADE's software that also allows development and dissemination of interactive
summary of findings tables.
Conclusion
EtD frameworks for developing recommendations and making decisions about tests lay
out the sequential steps in reviewing and assessing the different types of evidence
that need to be linked.
Keywords
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Article info
Publication history
Published online: February 27, 2016
Accepted:
January 20,
2016
Footnotes
Funding: This article has been partially funded by the European Commission FP7 Program (grant agreement 258583) as part of the DECIDE project. Sole responsibility lies with the authors and the European Commission is not responsible for any use that may be made of the information contained therein. The authors are members of the GRADE Working Group and its DECIDE project. PAC is supported by a Miguel Servet investigator contract from the Instituto de Salud Carlos III (CP09/00137). GRADEpro has been developed by members of the GRADE Working Group; it is freely accessible to nonprofit organizations. Revenue derived from the licensing of GRADEpro from for-profit organizations is reinvested in the maintenance and improvement of GRADEpro. The program code for GRADEpro remains a property of McMaster University.
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