Developing trustworthy recommendations as part of an urgent response (1-2 weeks): a GRADE concept paper

Elie A Akl¹, Rebecca L Morgan², Andrew A Rooney³, Brandiese Beverly³, Srinivasa Vittal Katikireddi⁴, Arnav Agarwal⁵, Brian S Alper⁶, Carlos Alva-Diaz⁷, Laura Amato⁸, Mohammed T Ansari⁹, Jan Brozek², Derek K Chu¹⁰, Philipp Dahm¹¹, Andrea J Darzi², Maicon Falavigna¹², Gerald Gartlehner¹³, Hector Pardo-Hernandez¹⁴, Valerie King¹⁵, Jitka Klugarová¹⁶, M W Miranda Langendam¹⁷, Craig Lockwood¹⁸, Manoj Mammen¹⁹, Alexander G Mathioudakis²⁰, Michael McCaul²¹, Joerg J Meerpohl²², Silvia Minozzi²³, Reem A Mustafa²⁴, Francesco Nonino²⁵, Thomas Piggott²⁶, Amir Qaseem²⁷, John Riva²⁸, Rachel Rodin²⁹, Nigar Sekercioglu², Nicole Skoetz³⁰, Gregory Traversy³¹, Kris Thayer³², Holger Schünemann²

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: ea32@aub.edu.lb.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
³ National Institute of Environmental Health Science, Durham, NC, USA.
⁴ MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3AX, UK.
⁵ Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.
⁶ Department of Family and Community Medicine, Medical Knowledge Office, EBSCO Information Services, University of Missouri-Columbia School of Medicine, 10 Estes Street, Ipswich, MA 01938, USA.
⁷ Universidad Científica del Sur, Facultad de Ciencias de la Salud, Panamericana, Sur km 19, Villa, Lima, Peru.
⁸ Department of Epidemiology, Lazio Regional Health Services Rome, via Cristoforo Colombo 112, 00147 Rome, Italy.
⁹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada.
¹⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Rm 3V49 McMaster University Medical Centre, Hamilton, ON L8S 4K1, Canada; Department of Medicine, Rm 3V49 McMaster University Medical Centre, Hamilton, ON L8S 4K1, Canada; The Research Institute of St. Joe's Hamilton, Rm 3V49 McMaster University Medical Centre, Hamilton, ON L8S 4K1, Canada.
¹¹ Department of Urology, Minneapolis VA Healthcare System, Urology Section, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, USA.
¹² Hospital Moinhos de Vento, Porto Alegre, Brazil.
¹³ Department for Evidence-based Medicine and Evaluation, RTI International, Danube University, Dr. Karl Dorrekstrasse, Krems Austria, 3040 East Cornwallis Rd, Research Triangle Park, NC, USA.
¹⁴ Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER de Epidemiología y Salud Pública (CIBERESP), Carrer Sant Antoni Maria Claret, 167, Pavelló 18, Planta Baja (Ground Floor), 08025 Barcelona, Spain.
¹⁵ Center for Evidence-based Policy, Oregon Health & Science University, 3030 South Moody Ave., Suite 250, Portland, OR 97201, USA.
¹⁶ Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
¹⁷ Amsterdam UMC, University of Amsterdam, Epidemiology and Data Science, Amsterdam Institute of Public Health, Meibergdreef 9, Amsterdam, the Netherlands.
¹⁸ JBI, School of Public Health, University of Adelaide, Level 3/55 King William Road, North Adelaide 5005, Australia.
¹⁹ Department of Medicine, State University of New York at Buffalo, 100 High Street, Buffalo, NY, USA.
²⁰ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, 2nd Floor, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, 2nd Floor, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK.
²¹ Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Teaching Building, Faculty of Medicine and Health Sciences, Francie van Zijl Drive, Bellville, Western Cape, South Africa.
²² Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Breisacher Strasse 153, 79110 Freiburg, Germany.
²³ Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
²⁴ Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA.
²⁵ IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Epidemiologia e Statistica, IRCCS-ISNB, Ospedale Bellaria, Via Altura, 3, 40139 Bologna, Italy.
²⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West 2C Area, Hamilton, Ontario L8S 4K1, Canada.
²⁷ American College of Physicians, 190 N Independence Mall West, Philadelphia, PA 19087, USA.
²⁸ Department of Family Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
²⁹ Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Ontario, Canada.
³⁰ Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Evidence-based Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 15, 50935 Cologne, Germany.
³¹ Public Health Agency of Canada, Ottawa, Ontario, Canada.
³² U.S. Environmental Protection Agency, Office of Research and Development (ORD, Center for Public Health and Environmental Assessment (CPHEA), Mail Code: B243-01, Building: Bldg B (Room B210I), Research Triangle Park, NC 27711, USA.

PMID: 33010401
PMCID: PMC7526592
DOI: 10.1016/j.jclinepi.2020.09.037

Developing trustworthy recommendations as part of an urgent response (1-2 weeks): a GRADE concept paper

Elie A Akl et al. J Clin Epidemiol. 2021 Jan.

. 2021 Jan:129:1-11.

doi: 10.1016/j.jclinepi.2020.09.037. Epub 2020 Sep 30.

Authors

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: ea32@aub.edu.lb.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
³ National Institute of Environmental Health Science, Durham, NC, USA.
⁴ MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3AX, UK.
⁵ Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada.
⁶ Department of Family and Community Medicine, Medical Knowledge Office, EBSCO Information Services, University of Missouri-Columbia School of Medicine, 10 Estes Street, Ipswich, MA 01938, USA.
⁷ Universidad Científica del Sur, Facultad de Ciencias de la Salud, Panamericana, Sur km 19, Villa, Lima, Peru.
⁸ Department of Epidemiology, Lazio Regional Health Services Rome, via Cristoforo Colombo 112, 00147 Rome, Italy.
⁹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada.
¹⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Rm 3V49 McMaster University Medical Centre, Hamilton, ON L8S 4K1, Canada; Department of Medicine, Rm 3V49 McMaster University Medical Centre, Hamilton, ON L8S 4K1, Canada; The Research Institute of St. Joe's Hamilton, Rm 3V49 McMaster University Medical Centre, Hamilton, ON L8S 4K1, Canada.
¹¹ Department of Urology, Minneapolis VA Healthcare System, Urology Section, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, USA.
¹² Hospital Moinhos de Vento, Porto Alegre, Brazil.
¹³ Department for Evidence-based Medicine and Evaluation, RTI International, Danube University, Dr. Karl Dorrekstrasse, Krems Austria, 3040 East Cornwallis Rd, Research Triangle Park, NC, USA.
¹⁴ Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER de Epidemiología y Salud Pública (CIBERESP), Carrer Sant Antoni Maria Claret, 167, Pavelló 18, Planta Baja (Ground Floor), 08025 Barcelona, Spain.
¹⁵ Center for Evidence-based Policy, Oregon Health & Science University, 3030 South Moody Ave., Suite 250, Portland, OR 97201, USA.
¹⁶ Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
¹⁷ Amsterdam UMC, University of Amsterdam, Epidemiology and Data Science, Amsterdam Institute of Public Health, Meibergdreef 9, Amsterdam, the Netherlands.
¹⁸ JBI, School of Public Health, University of Adelaide, Level 3/55 King William Road, North Adelaide 5005, Australia.
¹⁹ Department of Medicine, State University of New York at Buffalo, 100 High Street, Buffalo, NY, USA.
²⁰ Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, 2nd Floor, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, 2nd Floor, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK.
²¹ Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Teaching Building, Faculty of Medicine and Health Sciences, Francie van Zijl Drive, Bellville, Western Cape, South Africa.
²² Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Breisacher Strasse 153, 79110 Freiburg, Germany.
²³ Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
²⁴ Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA; Department of Health Research Methods, Evidence, and Impact, McMaster University, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA.
²⁵ IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Epidemiologia e Statistica, IRCCS-ISNB, Ospedale Bellaria, Via Altura, 3, 40139 Bologna, Italy.
²⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West 2C Area, Hamilton, Ontario L8S 4K1, Canada.
²⁷ American College of Physicians, 190 N Independence Mall West, Philadelphia, PA 19087, USA.
²⁸ Department of Family Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster University Medical Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
²⁹ Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Ontario, Canada.
³⁰ Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Evidence-based Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 15, 50935 Cologne, Germany.
³¹ Public Health Agency of Canada, Ottawa, Ontario, Canada.
³² U.S. Environmental Protection Agency, Office of Research and Development (ORD, Center for Public Health and Environmental Assessment (CPHEA), Mail Code: B243-01, Building: Bldg B (Room B210I), Research Triangle Park, NC 27711, USA.

PMID: 33010401
PMCID: PMC7526592
DOI: 10.1016/j.jclinepi.2020.09.037

Abstract

Objectives: The aim of this study is to propose an approach for developing trustworthy recommendations as part of urgent responses (1-2 week) in the clinical, public health, and health systems fields.

Study design and setting: We conducted a review of the literature, outlined a draft approach, refined the concept through iterative discussions, a workshop by the Grading of Recommendations Assessment, Development and Evaluation Rapid Guidelines project group, and obtained feedback from the larger Grading of Recommendations Assessment, Development and Evaluation working group.

Results: A request for developing recommendations within 2 week is the usual trigger for an urgent response. Although the approach builds on the general principles of trustworthy guideline development, we highlight the following steps: (1) assess the level of urgency; (2) assess feasibility; (3) set up the organizational logistics; (4) specify the question(s); (5) collect the information needed; (6) assess the adequacy of identified information; (7) develop the recommendations using one of the 4 potential approaches: adopt existing recommendations, adapt existing recommendations, develop new recommendations using existing adequate systematic review, or develop new recommendations using expert panel input; and (8) consider an updating plan.

Conclusion: An urgent response for developing recommendations requires building a cohesive, skilled, and highly motivated multidisciplinary team with the necessary clinical, scientific, and methodological expertise; adapting to shifting needs; complying with the principles of transparency; and properly managing conflicts of interest.

Keywords: GRADE; Pandemic; Trustworthy guideline; Urgent recommendation.

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Figures

**Fig. 1**
Steps involved in urgent guideline development.

**Fig. 2**
Steps involved in developing a new recommendation using panel input.

See this image and copyright information in PMC

References

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Developing trustworthy recommendations as part of an urgent response (1-2 weeks): a GRADE concept paper

Affiliations

Developing trustworthy recommendations as part of an urgent response (1-2 weeks): a GRADE concept paper

Authors

Affiliations

Abstract

Figures

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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