Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;115(1):60-71.
doi: 10.1111/vox.12852. Epub 2019 Nov 10.

The systematic use of evidence-based methodologies and technologies enhances shared decision-making in the 2018 International Consensus Conference on Patient Blood Management

Hans Van Remoortel  1 , Kari Aranko  2   3 , Markus M Mueller  4 , Emmy De Buck  1   5 , Dana Devine  6 , Gilles Folléa  7 , Patrick Meybohm  8 , Pierre Tiberghien  9 , Erica M Wood  10   11 , Philippe Vandekerckhove  5   12 , Erhard Seifried  2   4   10
Affiliations

The systematic use of evidence-based methodologies and technologies enhances shared decision-making in the 2018 International Consensus Conference on Patient Blood Management

Hans Van Remoortel et al. Vox Sang. 2020 Jan.

Abstract

Background and objectives: Patient Blood Management (PBM) aims to optimize the care of patients who might need a blood transfusion. The International Consensus Conference on PBM (ICC-PBM) aimed to develop evidence-based recommendations on three topics: preoperative anaemia, red blood cell transfusion thresholds and implementation of PBM programmes. This paper reports how evidence-based methodologies and technologies were used to enhance shared decision-making in formulating recommendations during the ICC-PBM.

Materials & methods: Systematic reviews on 17 PICO (Population, Intervention, Comparison, Outcomes) questions were conducted by a Scientific Committee (22 international topic experts and one methodologist) according to GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methodology. Evidence-based recommendations were formulated using Consensus Development Conference methodology.

Results: We screened 17 607 references and included 145 studies. The overall certainty in the evidence of effect estimates was generally low or very low. During the ICC, plenary sessions (100-200 stakeholders from a range of clinical disciplines and community representatives) were followed by closed sessions where multidisciplinary decision-making panels (>50 experts and patient organizations) formulated recommendations. Two chairs (content-expert and methodologist) moderated each session and two rapporteurs documented the discussions. The Evidence-to-Decision template (GRADEpro software) was used as the central basis in the process of formulating recommendations.

Conclusion: This ICC-PBM resulted in 10 clinical and 12 research recommendations supported by an international stakeholder group of experts in blood transfusion. Systematic, rigorous and transparent evidence-based methodology in a formal consensus format should be the new standard to evaluate (cost-) effectiveness of medical treatments, such as blood transfusion.

Keywords: anemia; patient blood management; red cell components; transfusion.

PubMed Disclaimer

Conflict of interest statement

Dr Van Remoortel reported receiving financial support/funding to his institution from organizers of the ICC‐PBM 2018 (see list of co‐sponsors listed for Dr Mueller below) during the conduct of the study. Dr Mueller reported receiving grants from the European Blood Alliance (EBA), American Association of Blood Banks (AABB), International Society of Blood Transfusion (ISBT), Deutsche Gesellschaft für Transfusionsmedizin und Immunhämatologie (DGTI), Societe Francaise de Transfusion Sanguine (SFTS) and Societa Italiana di Medicina Trasfusionale e Immunoematologia (SIMTI) during the conduct of the study and receiving personal fees from TerumoBCT outside the submitted work. Dr De Buck reported receiving financial support/funding to her institution from organizers of the ICC‐PBM 2018 (see list of co‐sponsors listed for Dr Mueller above) during the conduct of the study. Dr Devine reported receiving grants from Macopharma, TerumoBCT and Hemanext outside the submitted work. Dr Meybohm reported receiving grants, personal fees and nonfinancial support from B. Braun Melsungen, CSL Behring, Fresenius Kabi, and Vifor Pharma; receiving personal fees from Pharmacosmos outside the submitted work; and receiving research grants from the German Research Foundation (ME 3559/1‐1, ME 3559/3‐1), International Anesthesia Research Society, German Society of Anaesthesiology and Intensive Care Medicine, and European Society of Anaesthesiology. Dr Wood reported receiving grants from Celgene Corporation, CSL Behring, Australian Red Cross Blood Service, New Zealand Blood Service, Amgen, Abbvie, Bristol‐Myers Squibb, Janssen, Roche, Sanofi and Takeda outside the submitted work. Dr Seifried received personal fees from Vivor outside the submitted work and reported receiving grants from the European Blood Alliance (EBA), American Association of Blood Banks (AABB), International Society of Blood Transfusion (ISBT), Deutsche Gesellschaft für Transfusionsmedizin und Immunhämatologie (DGTI), Societe Francaise de Transfusion Sanguine (SFTS) and Societea Italiana di Medicina Transfusionale e Immunoematologia (SIMTI) during the conduct of the study. No other authors reported disclosures.

Figures

Figure 1
Figure 1
Overview of the key tasks to prepare the ICC‐PBM.
Figure 2
Figure 2
Promoting shared decision‐making in an international guideline project: the use of the Consensus Development Conference format, GRADE’s Evidence‐to‐Decision framework and software (GRADEpro) and opinion polls via smartphone or laptop application (MentimeterTM software).
See this image and copyright information in PMC

References

    1. World Health Organization : WHO global forum for blood safety: patient blood management, 2011. https://www.who.int/bloodsafety/events/gfbs_01_pbm/en/. (Last accessed 27 September 2019).
    1. Brouwers MC, Kho ME, Browman GP, et al: AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 2010; 182:E839–E842 - PMC - PubMed
    1. Guyatt G, Oxman AD, Akl EA, et al: Grade guidelines: 1. Introduction‐GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64:383–394 - PubMed
    1. Guyatt GH, Oxman AD, Kunz R, et al: What is "quality of evidence" and why is it important to clinicians? BMJ 2008; 336:995–998 - PMC - PubMed
    1. Guyatt GH, Oxman AD, Vist GE, et al: GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336:924–926 - PMC - PubMed

Publication types