Advertisement

GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist

  • Elie A. Akl
    Correspondence
    Corresponding author. Tel.: +961-1-374374.
    Affiliations
    Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon

    Department of Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon

    AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
    Search for articles by this author
  • Vivian Welch
    Affiliations
    Bruyére Research Institute, Bruyére Continuing Care and University of Ottawa, Bruyère St., Ottawa, Ontario, K1N 5C8, Canada
    Search for articles by this author
  • Kevin Pottie
    Affiliations
    Centre for Global Health, Institute of Population Health, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
    Search for articles by this author
  • Javier Eslava-Schmalbach
    Affiliations
    Group of Equity in Health, Faculty of Medicine, Universidad Nacional de Colombia, Edif. Uriel Gutiérrez, Bogotá D.C., Colombia

    Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion, Sociedad Colombiana de Anestesiología y ReanimaciónCra, 15 A No 120-74, Piso 4y5, Edif. Concord Center, Santa Fe de Bogotá, Colombia
    Search for articles by this author
  • Andrea Darzi
    Affiliations
    Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon

    AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
    Search for articles by this author
  • Ivan Sola
    Affiliations
    Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
    Search for articles by this author
  • Srinivasa Vittal Katikireddi
    Affiliations
    Public Health MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200, Renfield Street, Glasgow G2 3QB, Scotland
    Search for articles by this author
  • Jasvinder Singh
    Affiliations
    Department of Medicine, School of Medicine, Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233, USA

    Division of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), 1720 2nd Ave S, Birmingham, AL 35294, USA

    Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
    Search for articles by this author
  • M. Hassan Murad
    Affiliations
    Mayo Clinic Evidence-based Practice Center, Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
    Search for articles by this author
  • Joerg Meerpohl
    Affiliations
    Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité–U1153, Inserm/Université Paris Descartes, 1 place du Parvis Notre-Dame, 75004 Paris, France

    Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris, Cedex 04, France

    Cochrane Germany, Medical Center—University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
    Search for articles by this author
  • Roger Stanev
    Affiliations
    Institute of Technology, University of Washington, Tacoma, Washington, USA
    Search for articles by this author
  • Eddy Lang
    Affiliations
    Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada
    Search for articles by this author
  • Elizabeth Matovinovic
    Affiliations
    Faculty of Medicine, Chiang Mai University, Su Thep, Mueang Chiang Mai District, Chiang Mai 50200, Thailand
    Search for articles by this author
  • Beverley Shea
    Affiliations
    Ottawa Hospital Research Institute, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
    Search for articles by this author
  • Thomas Agoritsas
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada

    Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
    Search for articles by this author
  • Paul E. Alexander
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada

    Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
    Search for articles by this author
  • Alexandra Snellman
    Affiliations
    Socialstyrelsen, Rålambsvägen 3, Stockholm, 112 59, Sweden
    Search for articles by this author
  • Romina Brignardello-Petersen
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada

    Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada

    Evidence Based Dentistry Unit, Faculty of Dentistry, University of Chile, Av. Libertador Bernardo O'Higgins, Santiago 1058, Chile
    Search for articles by this author
  • David Gloss
    Affiliations
    Department of Neurology, Charleston Area Medical Center, 1201 Washington Street East, Suite 100, Charleston, WV 25301, USA
    Search for articles by this author
  • Lehana Thabane
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada

    Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
    Search for articles by this author
  • Chunhu Shi
    Affiliations
    Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester M13 9PL, UK
    Search for articles by this author
  • Airton T. Stein
    Affiliations
    Public Health Ufcspa, Ulbra and Conceicao Hospital, Av. Farroupilha, 8001, Bairro São José, Canoas (RS), Brasil
    Search for articles by this author
  • Ravi Sharaf
    Affiliations
    Long Island Jewish Medical Center North Shore University Hospital, 270-05 76th Ave, Queens, NY 11040, USA
    Search for articles by this author
  • Matthias Briel
    Affiliations
    Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland
    Search for articles by this author
  • Gordon Guyatt
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada

    Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
    Search for articles by this author
  • Holger Schünemann
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada

    Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada

    McMaster GRADE Center, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada

    Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
    Search for articles by this author
  • Peter Tugwell
    Affiliations
    The Centre for Global Health, Institute of Population Health, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
    Search for articles by this author

      Abstract

      Objective

      To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process.

      Study Design and Setting

      Literature review followed by group discussions and consensus building.

      Results

      The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages.

      Conclusion

      Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Eslava-Schmalbach J.
        • Sandoval-Vargas G.
        • Mosquera P.
        Incorporating equity into developing and implementing for evidence-based clinical practice guidelines.
        Revista de Salud Pública. 2011; 13: 339-351
        • Wyatt K.D.
        • Stuart L.M.
        • Brito J.P.
        • Carranza Leon B.
        • Domecq J.P.
        • Prutsky G.J.
        • et al.
        Out of context: clinical practice guidelines and patients with multiple chronic conditions: a systematic review.
        Med Care. 2014; 52: S92-S100
        • Shi C.H.
        • Tian J.H.
        • Wang Q.
        • Petkovic J.
        • Ren D.
        • Yang K.H.
        • et al.
        How equity is addressed in clinical practice guidelines: a content analysis.
        BMJ Open. 2014; 4: e005660
        • Welch V.A.
        • Petticrew M.
        • O'Neill J.
        • Waters E.
        • Armstrong R.
        • Bhutta Z.A.
        • et al.
        Health equity: evidence synthesis and knowledge translation methods.
        Syst Rev. 2013; 2: 43
        • Gordon G.
        • Oxman A.D.
        • Akl E.A.
        • Kunz R.
        • Vist G.
        • Brozek J.
        • et al.
        GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables.
        J Clin Epidemiol. 2011; 64: 383-394
        • Oxman A.D.
        Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity.
        Health Res Policy Syst. 2006; 4: 24
        • Dans A.M.
        • Dans L.
        • Oxman A.D.
        • Robinson V.
        • Acuin J.
        • Tugwell P.
        • et al.
        Assessing equity in clinical practice guidelines.
        J Clin Epidemiol. 2007; 60: 540-546
        • National Institute for Health and Care Excellence
        Positively equal. A guide to addressing equality issues in developing NICE clinical guidelines.
        2nd ed. 2012
        • Whitehead M.
        The concepts and principles of equity and health.
        Int J Health Serv. 1992; 22: 429-445
        • Organization WH
        WHO handbook for guideline development.
        2nd ed. 2014
        • Aldrich R.
        • Kemp L.
        • Williams J.S.
        • Harris E.
        • Simpson S.
        • Wilson A.
        • et al.
        Using socioeconomic evidence in clinical practice guidelines.
        Br Med J. 2003; 327: 1283-1285
        • Keuken D.G.
        • Haafkens J.A.
        • Moerman C.J.
        • Klazinga N.S.
        • ter Riet G.
        Attention to sex-related factors in the development of clinical practice guidelines.
        J women's Health. 2007; 16: 82-92
        • Schünemann H.J.
        • Wiercioch W.
        • Etxeandia I.
        • Falavigna M.
        • Santesso N.
        • Mustafa R.
        • et al.
        Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.
        Can Med Assoc J. 2014; 186: E123-E142
        • O'neill J.
        • Tabish H.
        • Welch V.
        • Petticrew M.
        • Pottie K.
        • Clarke M.
        • et al.
        Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health.
        J Clin Epidemiol. 2014; 67: 56-64
        • Cowan K.
        • Oliver S.
        The James Lind Alliance Guidebook.
        5th ed. 2013
        • Mizen L.A.
        • Macfie M.L.
        • Findlay L.
        • Cooper S.A.
        • Melville C.A.
        Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities.
        Implement Sci. 2012; 7: 42
        • Anderson B.O.
        Evidence-based methods to address disparities in global cancer control: the development of guidelines in Asia.
        Lancet Oncol. 2013; 14: 1154-1155
        • Katikireddi S.V.
        • Valles S.A.
        Coupled ethical-epistemic analysis of public health research and practice: categorizing variables to improve population health and equity.
        Am J Public Health. 2015; 105: e36-e42
        • Benach J.
        • Malmusi D.
        • Yasui Y.
        • Martinez J.M.
        A new typology of policies to tackle health inequalities and scenarios of impact based on Rose's population approach.
        J Epidemiol Community Health. 2013; 67: 286-291
        • O'Mara-Eves A.
        • Brunton G.
        • McDaid D.
        • Oliver S.
        • Kavanagh J.
        • Jamal F.
        • et al.
        Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis.
        Public Health Research 1.4, Southampton (UK)2013
        • Legare F.
        • Boivin A.
        • van der Weijden T.
        • Pakenham C.
        • Burgers J.
        • Legare J.
        • et al.
        Patient and public involvement in clinical practice guidelines: a knowledge synthesis of existing programs.
        Med Decis making. 2011; 31: E45-E74
        • Organization WH
        Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people.
        2011
        • Organization WH
        Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.
        2013
        • Williamson YSaC
        The HIV-1 Epidemic: Low- to Middle-Income Countries.
        Cold Spring Harbor Pespectives in Medicine, 2012: 2
        • Organization WH
        Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries.
        2012 (Recommendations for a public health approach)
        • Gordon H.
        • Oxman A.D.
        • Kunz R.
        • Atkins D.
        • Brozek J.
        • et al.
        GRADE guidelines: 2. Framing the question and deciding on important outcomes.
        J Clin Epidemiol. 2010; 64: 395-400
        • Guyatt G.H.
        • Schünemann H.J.
        • Djulbegovic B.
        • Akl E.A.
        Guideline panels should not GRADE good practice statements.
        J Clin Epidemiol. 2015; 68: 597-600
      1. NICE. UK Database of Uncertainties about the Effects of Treatments (UK DUETs): a resource to make uncertainties explicit and to help prioritise new research.

      2. Initiative C. Core outcome measures in effectiveness trials.

        • Garrido M.M.
        • Harrington S.T.
        • Prigerson H.G.
        End-of-life treatment preferences: a key to reducing ethnic/racial disparities in advance care planning?.
        Cancer. 2014; 120: 3981-3986
        • Balshem H.
        • Helfand M.
        • Schünemann H.J.
        • Oxman A.D.
        • Kunz R.
        • Brozek J.
        • et al.
        GRADE guidelines: 3. Rating the quality of evidence.
        J Clin Epidemiol. 2011; 64: 401-406
        • Ranganathan M.
        • Bhopal R.
        Exclusion and inclusion of nonwhite ethnic minority groups in 72 North American and European cardiovascular cohort studies.
        PLoS Med. 2006; 3: e44
        • Malta M.
        • M M.
        • Mello M.B.
        • Pascom A.R.
        • Linhares Y.
        • Bastos F.I.
        HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis.
        BMJ Public Health. 2010; 10: 317
        • Eikemo T.A.
        • Hoffmann R.
        • Kulik M.C.
        • Kulhanova I.
        • Toch-Marquardt M.
        • Menvielle G.
        • et al.
        How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations.
        PLoS One. 2014; 9: e110952
        • Ogilvie D.
        • Hamilton V.
        • Egan M.
        • Petticrew M.
        Systematic reviews of health effects of social interventions: 1. Finding the evidence: how far should you go?.
        J Epidemiol Community Health. 2005; 59: 804-808
        • Welch V.P.M.
        • Tugwell P.
        • Moher D.
        • O'Neill J.
        • Waters E.
        • White H.
        • the PRISMA- Equity Bellagio group
        PRISMA-equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity.
        PLoS Med. 2012; 9: e1001333
        • Cooper C.
        • Levay P.
        • Lorenc T.
        • Craig G.M.
        A population search filter for hard-to-reach populations increased search efficiency for a systematic review.
        J Clin Epidemiol. 2014; 67: 554-559
        • Tugwell P.
        • Petticrew M.
        • Kristjansson E.
        • Welch V.
        • Ueffing E.
        • Waters E.
        • et al.
        Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health.
        BMJ. 2010; 341: c4739
        • Andrews J.
        • Guyatt G.
        • Oxman A.D.
        • Alderson P.
        • Dahm P.
        • Falck-Ytter Y.
        • et al.
        GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations.
        J Clin Epidemiol. 2013; 66: 719-725
      3. Organization WH. The use of bedaquiline in the treatment of multidrug-resistant tuberculosis - Interim policy guidance.

        • Domecq J.P.
        • Prutsky G.
        • Elraiyah T.
        • Wang Z.
        • Nabhan M.
        • Shippee N.
        • et al.
        Patient engagement in research: a systematic review.
        BMC Health Serv Res. 2014; 14: 89