Grading quality of evidence and strength of recommendations in clinical practice guidelines

J. L. Brozek, McMaster University School of Medicine
E. A. Akl, McMaster University School of Medicine
E. Compalati, University of Genoa
J. Kreis, Johns Hopkins Bloomberg School of Public Health
L. Terracciano, University of Milan
A. Fiocchi, University of Milan
E. Ueffing, University of Ottawa
J. Andrews, Vanderbilt University
P. Alonso-Coello, Institute of Biomedical Research-CIBER of Epidemiology and Public Health (CIBERESP-IIB Sant Paul)
J. J. Meerpohl, University Medical Center Freiburg
D. M. Lang, Allergy/Immunology Section, Respiratory Institute, Cleveland Clinic
R. Jaeschke, McMaster University
J. W. Williams Jr, Duke University
B. Phillips, University of York
A. Lethaby, University of Auckland
P. Bossuyt, University of Amsterdam
P. Glasziou, University of Oxford
M. Helfand, Oregon Health & Science University
J. Watine, Hopital de Rodez
M. Afilalo, McGill University
V. Welch, University of Ottawa
A. Montedori, Regional Health Authority of Umbria
I. Abraha, Regional Health Authority of Umbria
A. R. Horvath, University of Sydney
J. Bousquet, Hopital Arnaud de Villeneuve
G. H. Guyatt, McMaster University School of Medicine
H. J. Schünemann, McMaster University School of Medicine

Document Type Journal Article

Citation only.

Brozek, J. L., Akl, E. A., Compalati, E., Kreis, J., Terracciano, L., Fiocchi, A., Ueffing, E., Andrews, J., Alonso-Coello, P., Meerpohl, J. J., Lang, D. M., Jaeschke, R., Williams Jr, J. W., Phillips, B., Lethaby, A., Bossuyt, P., Glasziou, P., Helfand, M., Watine, J., Afilalo, M., Welch, V., Montedori, A., Abraha, I., Horvath, A. R., Bousquet, J., Guyatt, G. H. & Schünemann, H. J. (2011). Grading quality of evidence and strength of recommendations in clinical practice guidelines Part 3 of 3. The GRADE approach to developing recommendations. Allergy: European journal of allergy and clinical immunology, 66(5), pp. 588-595.

Access the publisher's website.

© John Wiley & Sons A/S, 2011

Abstract

This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients’ values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients’ values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.

 

This document has been peer reviewed.