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

doi:10.1016/j.jclinepi.2017.01.017

. 2017 Oct:90:68-75.

doi: 10.1016/j.jclinepi.2017.01.017. Epub 2017 May 9.

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

Elie A Akl¹, Vivian Welch², Kevin Pottie³, Javier Eslava-Schmalbach⁴, Andrea Darzi⁵, Ivan Sola⁶, Srinivasa Vittal Katikireddi⁷, Jasvinder Singh⁸, M Hassan Murad⁹, Joerg Meerpohl¹⁰, Roger Stanev¹¹, Eddy Lang¹², Elizabeth Matovinovic¹³, Beverley Shea¹⁴, Thomas Agoritsas¹⁵, Paul E Alexander¹⁵, Alexandra Snellman¹⁶, Romina Brignardello-Petersen¹⁷, David Gloss¹⁸, Lehana Thabane¹⁵, Chunhu Shi¹⁹, Airton T Stein²⁰, Ravi Sharaf²¹, Matthias Briel²², Gordon Guyatt¹⁵, Holger Schünemann²³, Peter Tugwell²⁴

Affiliations

¹ 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. Electronic address: ea32@aub.edu.lb.
² Bruyére Research Institute, Bruyére Continuing Care and University of Ottawa, Bruyère St., Ottawa, Ontario, K1N 5C8, Canada.
³ Centre for Global Health, Institute of Population Health, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada.
⁴ 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.
⁵ 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.
⁶ 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.
⁷ Public Health MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200, Renfield Street, Glasgow G2 3QB, Scotland.
⁸ 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.
⁹ Mayo Clinic Evidence-based Practice Center, Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
¹⁰ 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.
¹¹ Institute of Technology, University of Washington, Tacoma, Washington, USA.
¹² Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada.
¹³ Faculty of Medicine, Chiang Mai University, Su Thep, Mueang Chiang Mai District, Chiang Mai 50200, Thailand.
¹⁴ Ottawa Hospital Research Institute, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada.
¹⁵ 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.
¹⁶ Socialstyrelsen, Rålambsvägen 3, Stockholm, 112 59, Sweden.
¹⁷ 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.
¹⁸ Department of Neurology, Charleston Area Medical Center, 1201 Washington Street East, Suite 100, Charleston, WV 25301, USA.
¹⁹ 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.
²⁰ Public Health Ufcspa, Ulbra and Conceicao Hospital, Av. Farroupilha, 8001, Bairro São José, Canoas (RS), Brasil.
²¹ Long Island Jewish Medical Center North Shore University Hospital, 270-05 76th Ave, Queens, NY 11040, USA.
²² Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland.
²³ 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.
²⁴ The Centre for Global Health, Institute of Population Health, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada.

PMID: 28499847
PMCID: PMC6538524
DOI: 10.1016/j.jclinepi.2017.01.017

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

Elie A Akl et al. J Clin Epidemiol. 2017 Oct.

. 2017 Oct:90:68-75.

doi: 10.1016/j.jclinepi.2017.01.017. Epub 2017 May 9.

Authors

Affiliations

¹ 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. Electronic address: ea32@aub.edu.lb.
² Bruyére Research Institute, Bruyére Continuing Care and University of Ottawa, Bruyère St., Ottawa, Ontario, K1N 5C8, Canada.
³ Centre for Global Health, Institute of Population Health, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada.
⁴ 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.
⁵ 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.
⁶ 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.
⁷ Public Health MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200, Renfield Street, Glasgow G2 3QB, Scotland.
⁸ 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.
⁹ Mayo Clinic Evidence-based Practice Center, Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
¹⁰ 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.
¹¹ Institute of Technology, University of Washington, Tacoma, Washington, USA.
¹² Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada.
¹³ Faculty of Medicine, Chiang Mai University, Su Thep, Mueang Chiang Mai District, Chiang Mai 50200, Thailand.
¹⁴ Ottawa Hospital Research Institute, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada.
¹⁵ 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.
¹⁶ Socialstyrelsen, Rålambsvägen 3, Stockholm, 112 59, Sweden.
¹⁷ 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.
¹⁸ Department of Neurology, Charleston Area Medical Center, 1201 Washington Street East, Suite 100, Charleston, WV 25301, USA.
¹⁹ 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.
²⁰ Public Health Ufcspa, Ulbra and Conceicao Hospital, Av. Farroupilha, 8001, Bairro São José, Canoas (RS), Brasil.
²¹ Long Island Jewish Medical Center North Shore University Hospital, 270-05 76th Ave, Queens, NY 11040, USA.
²² Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland.
²³ 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.
²⁴ The Centre for Global Health, Institute of Population Health, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada.

PMID: 28499847
PMCID: PMC6538524
DOI: 10.1016/j.jclinepi.2017.01.017

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: Disadvantaged; GRADE; Guidelines; Health equity; Special populations; Underserved.

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References

1. Eslava-Schmalbach J, Sandoval-Vargas Gisella, Mosquera Paola. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines. Revista de Salud Pública. 2011;13:339–51. - PubMed
1. Wyatt KD, Stuart LM, Brito JP, Carranza Leon B, Domecq JP, Prutsky GJ, et al. Out of context: clinical practice guidelines and patients with multiple chronic conditions: a systematic review. Medical care. 2014;52(Suppl 3):S92–S100. - PubMed
1. Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, et al. Patient engagement in research: a systematic review. BMC health services research. 2014;14:89. - PMC - PubMed
1. Welch VA, Petticrew M, O'Neill J, Waters E, Armstrong R, Bhutta ZA, et al. Health equity: evidence synthesis and knowledge translation methods. Systematic reviews. 2013;2:43. - PMC - PubMed
1. Guyatt Gordon H, O AD, Akl Elie A, Kunz Regina, Vist Gunn, Brozek Jan, Norris Susan, Falck-Ytter Yngve, Glasziou Paul, deBeer Hans, Jaeschke Roman, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. 2011;64:383–94. - PubMed

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[1] Eslava-Schmalbach J, Sandoval-Vargas Gisella, Mosquera Paola. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines. Revista de Salud Pública. 2011;13:339–51. - PubMed

[2] Eslava-Schmalbach J, Sandoval-Vargas Gisella, Mosquera Paola. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines. Revista de Salud Pública. 2011;13:339–51. - PubMed

[3] Wyatt KD, Stuart LM, Brito JP, Carranza Leon B, Domecq JP, Prutsky GJ, et al. Out of context: clinical practice guidelines and patients with multiple chronic conditions: a systematic review. Medical care. 2014;52(Suppl 3):S92–S100. - PubMed

[4] Wyatt KD, Stuart LM, Brito JP, Carranza Leon B, Domecq JP, Prutsky GJ, et al. Out of context: clinical practice guidelines and patients with multiple chronic conditions: a systematic review. Medical care. 2014;52(Suppl 3):S92–S100. - PubMed

[5] Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, et al. Patient engagement in research: a systematic review. BMC health services research. 2014;14:89. - PMC - PubMed

[6] Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, et al. Patient engagement in research: a systematic review. BMC health services research. 2014;14:89. - PMC - PubMed

[7] Welch VA, Petticrew M, O'Neill J, Waters E, Armstrong R, Bhutta ZA, et al. Health equity: evidence synthesis and knowledge translation methods. Systematic reviews. 2013;2:43. - PMC - PubMed

[8] Welch VA, Petticrew M, O'Neill J, Waters E, Armstrong R, Bhutta ZA, et al. Health equity: evidence synthesis and knowledge translation methods. Systematic reviews. 2013;2:43. - PMC - PubMed

[9] Guyatt Gordon H, O AD, Akl Elie A, Kunz Regina, Vist Gunn, Brozek Jan, Norris Susan, Falck-Ytter Yngve, Glasziou Paul, deBeer Hans, Jaeschke Roman, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. 2011;64:383–94. - PubMed

[10] Guyatt Gordon H, O AD, Akl Elie A, Kunz Regina, Vist Gunn, Brozek Jan, Norris Susan, Falck-Ytter Yngve, Glasziou Paul, deBeer Hans, Jaeschke Roman, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. 2011;64:383–94. - PubMed

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

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

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