A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations

Tamara Lotfi¹, Anisa Hajizadeh², Lorenzo Moja³, Elie A Akl⁴, Thomas Piggott², Tamara Kredo⁵, Miranda W Langendam⁶, Alfonso Iorio⁷, Miloslav Klugar⁸, Jitka Klugarová⁸, Ignacio Neumann⁹, Wojtek Wiercioch¹, Grigorios I Leontiadis¹⁰, Lawrence Mbuagbaw¹¹, Alexis F Turgeon¹², Joerg Meerpohl¹³, Adrienne Stevens¹, Jan Brozek¹, Nancy Santesso¹, Kevin Pottie¹⁴, Omar Dewidar¹⁴, Signe A Flottorp¹⁵, Justine Karpusheff¹⁶, Zuleika Saz-Parkinson¹⁷, María X Rojas¹⁸, Elena Parmelli¹⁹, Derek K Chu⁷, Peter Tugwell¹⁴, Vivian Welch¹⁴, Marc T Avey²⁰, Romina Brignardello-Petersen², Joseph L Mathew²¹, Zachary Munn²², Robby Nieuwlaat², Nathan Ford²³, Amir Qaseem²⁴, Lisa M Askie²⁵, Holger J Schünemann²⁶

Affiliations

¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada.
³ Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁵ Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
⁶ Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Department of Medicine, McMaster University, Hamilton ,ON, Canada.
⁸ The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre); Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹⁰ Department of Medicine, McMaster University, Hamilton ,ON, Canada.
¹¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Biostatistics Unit/The Research Institute, St Joseph's Healthcare, Hamilton ,ON, Canada.
¹² Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City ,QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Québec City ,QC, Canada.
¹³ Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
¹⁴ School of Epidemiology and Public Health, University of Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa.
¹⁵ Norwegian Institute of Public Health, Oslo, Norway; University of Oslo, Oslo, Norway.
¹⁶ National Institute for Health and Care Excellence, United Kingdom.
¹⁷ Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias. Madrid, Spain.
¹⁸ Department of Clinical Epidemiology and Public Health, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau).
¹⁹ European Commission, Joint Research Centre (JRC), Ispra, Italy.
²⁰ Public Health Agency of Canada, Canada.
²¹ Postgraduate Institute of Medical Education and Research, Chandigarh, India.
²² Joanna Briggs Institute Faculty of Health and Medical Sciences The University of Adelaide, Australia.
²³ Department of HIV, Hepatitis and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland.
²⁴ American College of Physicians, Philadelphia, PA, USA.
²⁵ Quality Assurance of Norms and Standards Department, Science Division, World Health Organization, Geneva, Switzerland.
²⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada; Department of Medicine, McMaster University, Hamilton ,ON, Canada; Dipartimento di Scienze Biomediche Humanitas University, Milan, Italy. Electronic address: holger.schunemann@mcmaster.ca.

PMID: 34562579
DOI: 10.1016/j.jclinepi.2021.09.028

A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations

Tamara Lotfi et al. J Clin Epidemiol. 2022 Jan.

. 2022 Jan:141:161-171.

doi: 10.1016/j.jclinepi.2021.09.028. Epub 2021 Sep 23.

Authors

Affiliations

¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada.
³ Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁵ Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
⁶ Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Department of Medicine, McMaster University, Hamilton ,ON, Canada.
⁸ The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre); Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
¹⁰ Department of Medicine, McMaster University, Hamilton ,ON, Canada.
¹¹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Biostatistics Unit/The Research Institute, St Joseph's Healthcare, Hamilton ,ON, Canada.
¹² Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City ,QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Center, Québec City ,QC, Canada.
¹³ Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
¹⁴ School of Epidemiology and Public Health, University of Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa; Bruyère Research Institute, Ottawa, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, University of Ottawa.
¹⁵ Norwegian Institute of Public Health, Oslo, Norway; University of Oslo, Oslo, Norway.
¹⁶ National Institute for Health and Care Excellence, United Kingdom.
¹⁷ Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias. Madrid, Spain.
¹⁸ Department of Clinical Epidemiology and Public Health, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau).
¹⁹ European Commission, Joint Research Centre (JRC), Ispra, Italy.
²⁰ Public Health Agency of Canada, Canada.
²¹ Postgraduate Institute of Medical Education and Research, Chandigarh, India.
²² Joanna Briggs Institute Faculty of Health and Medical Sciences The University of Adelaide, Australia.
²³ Department of HIV, Hepatitis and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland.
²⁴ American College of Physicians, Philadelphia, PA, USA.
²⁵ Quality Assurance of Norms and Standards Department, Science Division, World Health Organization, Geneva, Switzerland.
²⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ,ON, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton , ON, Canada; Department of Medicine, McMaster University, Hamilton ,ON, Canada; Dipartimento di Scienze Biomediche Humanitas University, Milan, Italy. Electronic address: holger.schunemann@mcmaster.ca.

PMID: 34562579
DOI: 10.1016/j.jclinepi.2021.09.028

Abstract

Objective: To propose a taxonomy and framework that identifies and presents actionable statements in guidelines.

Study design and setting: We took an iterative approach reviewing case studies of guidelines produced by the World Health Organization and the American Society of Hematology to develop an initial conceptual framework. We then tested it using randomly selected recommendations from published guidelines addressing COVID-19 from different organizations, evaluated its results, and refined it before retesting. The urgency and availability of evidence for development of these recommendations varied. We consulted with experts in research methodology and guideline developers to improve the final framework.

Results: The resulting taxonomy and framework distinguishes five types of actional statements: formal recommendations; research recommendations; good practice statements; implementation considerations, tools and tips; and informal recommendations. These statements should respond to a priori established criteria and require a clear structure and recognizable presentation in a guideline. Most importantly, this framework identifies informal recommendations that differ from formal recommendations by how they consider evidence and in their development process.

Conclusion: The identification, standardization and explicit labelling of actionable statements according to the framework may support guideline developers to create actionable statements with clear intent, avoid informal recommendations and improve their understanding and implementation by users.

Keywords: GRADE; Guidelines; Policy; Practice statements; Recommendations; Standards.

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A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations

Affiliations

A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations

Authors

Affiliations

Abstract

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical