GRADE guidelines: 22. The GRADE approach for tests and strategies—from test accuracy to patient-important outcomes and recommendations

the GRADE Working Group

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence. Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences. Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can—and often does—lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making. Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use.

Original languageEnglish (US)
JournalJournal of Clinical Epidemiology
DOIs
StatePublished - Jan 1 2019

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Guidelines
Decision Support Techniques
Early Detection of Cancer
Routine Diagnostic Tests
Uterine Cervical Neoplasms
Decision Making
Health
Population

Keywords

  • Diagnosis
  • Frameworks
  • GRADE
  • Guidelines
  • Recommendations
  • Systematic reviews
  • Tests

ASJC Scopus subject areas

  • Epidemiology

Cite this

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title = "GRADE guidelines: 22. The GRADE approach for tests and strategies—from test accuracy to patient-important outcomes and recommendations",
abstract = "Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence. Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences. Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can—and often does—lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making. Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use.",
keywords = "Diagnosis, Frameworks, GRADE, Guidelines, Recommendations, Systematic reviews, Tests",
author = "{the GRADE Working Group} and Sch{\"u}nemann, {Holger J.} and Mustafa, {Reem A.} and Jan Brozek and Nancy Santesso and Bossuyt, {Patrick M.} and Steingart, {Karen R.} and Mariska Leeflang and Stefan Lange and Tommaso Trenti and Miranda Langendam and Rob Scholten and Lotty Hooft and Murad, {Mohammad H} and Roman Jaeschke and Anne Rutjes and Jasvinder Singh and Mark Helfand and Paul Glasziou and Ingrid Arevalo-Rodriguez and Akl, {Elie A.} and Deeks, {Jonathan J.} and Guyatt, {Gordon H.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jclinepi.2019.02.003",
language = "English (US)",
journal = "Journal of Clinical Epidemiology",
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TY - JOUR

T1 - GRADE guidelines

T2 - 22. The GRADE approach for tests and strategies—from test accuracy to patient-important outcomes and recommendations

AU - the GRADE Working Group

AU - Schünemann, Holger J.

AU - Mustafa, Reem A.

AU - Brozek, Jan

AU - Santesso, Nancy

AU - Bossuyt, Patrick M.

AU - Steingart, Karen R.

AU - Leeflang, Mariska

AU - Lange, Stefan

AU - Trenti, Tommaso

AU - Langendam, Miranda

AU - Scholten, Rob

AU - Hooft, Lotty

AU - Murad, Mohammad H

AU - Jaeschke, Roman

AU - Rutjes, Anne

AU - Singh, Jasvinder

AU - Helfand, Mark

AU - Glasziou, Paul

AU - Arevalo-Rodriguez, Ingrid

AU - Akl, Elie A.

AU - Deeks, Jonathan J.

AU - Guyatt, Gordon H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence. Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences. Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can—and often does—lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making. Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use.

AB - Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence. Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences. Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can—and often does—lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making. Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use.

KW - Diagnosis

KW - Frameworks

KW - GRADE

KW - Guidelines

KW - Recommendations

KW - Systematic reviews

KW - Tests

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