Abstract
Background The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. Objective To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly regarding discordant recommendations. Data sources Senior active GRADE methodologists who had served on at least two WHO panels and were an author on at least one peer-reviewed published article on GRADE methodology. Methods Five eligible methodologists participated in detailed semistructured interviews. Respondents answered questions regarding how they were viewed by other panelists and WHO leadership, and how they handled situations when panelists made discordant recommendations they felt were inappropriate. They also provided information on how the process can be improved. Interviews were recorded and transcribed, and inductive content analysis was used to derive codes, categories, and emergent themes. Results Three themes emerged from the interviews of five methodologists: (1) The perceived role of methodologists in the process, (2) Contributors to discordant recommendations, and (3) Strategies for improvement. Salient findings included (1) a perceived tension between methodologists and WHO panels as a result of panel members' resistance to adhering to GRADE guidance; (2) both financial and nonfinancial conflicts of interest among panel members as an explanation for discordant recommendations; and (3) the need for greater clarity of, and support for, the role of methodologists as co-chairs of panels. Conclusions These findings suggest that the role of the GRADE methodologist as a co-chair needs to be clarified by the WHO leadership. They further suggest the need for additional training for panelists, quality monitoring, and feedback to ensure optimal use of GRADE in guideline development at WHO.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 123-128 |
| Number of pages | 6 |
| Journal | Journal of Clinical Epidemiology |
| Volume | 70 |
| DOIs | |
| State | Published - Feb 1 2016 |
Fingerprint
Keywords
- Discordant recommendations
- Financial conflicts of interest
- GRADE
- Guidelines
- Low confidence
- Methodologist
- Nonfinancial conflicts of interest
- Panel
- Strong recommendation
- WHO
ASJC Scopus subject areas
- Epidemiology
Cite this
Senior GRADE methodologists encounter challenges as part of WHO guideline development panels : An inductive content analysis. / Alexander, Paul E.; Li, Shelly Anne; Gionfriddo, Michael R.; Stoltzfus, Rebecca J.; Neumann, Ignacio; Brito Campana, Juan; Djulbegovic, Benjamin; Montori, Victor Manuel; Schünemann, Holger J.; Guyatt, Gordon H.
In: Journal of Clinical Epidemiology, Vol. 70, 01.02.2016, p. 123-128.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Senior GRADE methodologists encounter challenges as part of WHO guideline development panels
T2 - An inductive content analysis
AU - Alexander, Paul E.
AU - Li, Shelly Anne
AU - Gionfriddo, Michael R.
AU - Stoltzfus, Rebecca J.
AU - Neumann, Ignacio
AU - Brito Campana, Juan
AU - Djulbegovic, Benjamin
AU - Montori, Victor Manuel
AU - Schünemann, Holger J.
AU - Guyatt, Gordon H.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. Objective To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly regarding discordant recommendations. Data sources Senior active GRADE methodologists who had served on at least two WHO panels and were an author on at least one peer-reviewed published article on GRADE methodology. Methods Five eligible methodologists participated in detailed semistructured interviews. Respondents answered questions regarding how they were viewed by other panelists and WHO leadership, and how they handled situations when panelists made discordant recommendations they felt were inappropriate. They also provided information on how the process can be improved. Interviews were recorded and transcribed, and inductive content analysis was used to derive codes, categories, and emergent themes. Results Three themes emerged from the interviews of five methodologists: (1) The perceived role of methodologists in the process, (2) Contributors to discordant recommendations, and (3) Strategies for improvement. Salient findings included (1) a perceived tension between methodologists and WHO panels as a result of panel members' resistance to adhering to GRADE guidance; (2) both financial and nonfinancial conflicts of interest among panel members as an explanation for discordant recommendations; and (3) the need for greater clarity of, and support for, the role of methodologists as co-chairs of panels. Conclusions These findings suggest that the role of the GRADE methodologist as a co-chair needs to be clarified by the WHO leadership. They further suggest the need for additional training for panelists, quality monitoring, and feedback to ensure optimal use of GRADE in guideline development at WHO.
AB - Background The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. Objective To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly regarding discordant recommendations. Data sources Senior active GRADE methodologists who had served on at least two WHO panels and were an author on at least one peer-reviewed published article on GRADE methodology. Methods Five eligible methodologists participated in detailed semistructured interviews. Respondents answered questions regarding how they were viewed by other panelists and WHO leadership, and how they handled situations when panelists made discordant recommendations they felt were inappropriate. They also provided information on how the process can be improved. Interviews were recorded and transcribed, and inductive content analysis was used to derive codes, categories, and emergent themes. Results Three themes emerged from the interviews of five methodologists: (1) The perceived role of methodologists in the process, (2) Contributors to discordant recommendations, and (3) Strategies for improvement. Salient findings included (1) a perceived tension between methodologists and WHO panels as a result of panel members' resistance to adhering to GRADE guidance; (2) both financial and nonfinancial conflicts of interest among panel members as an explanation for discordant recommendations; and (3) the need for greater clarity of, and support for, the role of methodologists as co-chairs of panels. Conclusions These findings suggest that the role of the GRADE methodologist as a co-chair needs to be clarified by the WHO leadership. They further suggest the need for additional training for panelists, quality monitoring, and feedback to ensure optimal use of GRADE in guideline development at WHO.
KW - Discordant recommendations
KW - Financial conflicts of interest
KW - GRADE
KW - Guidelines
KW - Low confidence
KW - Methodologist
KW - Nonfinancial conflicts of interest
KW - Panel
KW - Strong recommendation
KW - WHO
UR - http://www.scopus.com/inward/record.url?scp=84957706017&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84957706017&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2015.09.003
DO - 10.1016/j.jclinepi.2015.09.003
M3 - Article
C2 - 26385188
AN - SCOPUS:84957706017
VL - 70
SP - 123
EP - 128
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
SN - 0895-4356
ER -