A number of factors explain why WHO guideline developers make strong recommendations inconsistent with GRADE guidance

Journal of Clinical Epidemiology

Volumn 70, Issue , 2016, Pages 111-122

  Alexander, Paul E ^a   Gionfriddo, Michael R ^b   Li, Shelly Anne ^a   Bero, Lisa ^c   Stoltzfus, Rebecca J ^d   Neumann, Ignacio ^a,e   Brito, Juan P ^b   Djulbegovic, Benjamin ^f   Montori, Victor M ^b   Norris, Susan L ^g   Schünemann, Holger J ^h   Thabane, Lehana ⁱ   Guyatt, Gordon H ^h  

^a MCMASTER UNIVERSITY   (Canada)

^b MAYO CLINIC   (United States)

^c UNIVERSITY OF SYDNEY   (Australia)

^d Department of Obstetrics Gynecology   (United States)

^e PONTIFICIA UNIVERSIDAD CATÓLICA DE CHILE   (Chile)

^f H LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE   (United States)

^g WORLD HEALTH ORGANIZATION   (Switzerland)

^h MCMASTER UNIVERSITY MEDICAL CENTRE   (Canada)

ⁱ CENTRE FOR EVALUATION OF MEDICINES   (Canada)

Author keywords

Discordant recommendations; GRADE methods; Inconsistent with GRADE guidance; Interviews; Qualitative descriptive study; Strong recommendations low quality evidence; World Health Organization

Indexed keywords

ARTICLE; CLINICAL EVALUATION; GRADING OF RECOMMENDATION ASSESSMENT DEVELOPMENT AND EVALUATION; HUMAN; INTERVIEW; PRACTICE GUIDELINE; PRIORITY JOURNAL; QUALITATIVE RESEARCH; WORLD HEALTH ORGANIZATION; EVIDENCE BASED MEDICINE; STANDARDS;

EVIDENCE-BASED MEDICINE; GUIDELINE ADHERENCE; HUMANS; PRACTICE GUIDELINES AS TOPIC; WORLD HEALTH ORGANIZATION;

EID: 84957434754     PISSN: 08954356     EISSN: 18785921     Source Type: Journal    
DOI: 10.1016/j.jclinepi.2015.09.006     Document Type: Article

References (37)

1. H.J. Schünemann, A. Fretheim, A.D. Oxman WHO Advisory Committee on Health Research Improving the use of research evidence in guideline development: 1. guidelines for guidelines Health Res Policy Syst 4 2006 13
2. A.D. Oxman, J.N. Lavis, and A. Fretheim Use of evidence in WHO recommendations Lancet 369 2007 1883 1889
3. G. Guyatt, A.D. Oxyman, E.A. Akl, R. Kunz, G. Vist, J. Brozek, and et al. GRADE guidelines: 1. Introduction - GRADE evidence profiles and summary of findings tables J Clin Epidemiol 64 2011 383 394 Available at http://www.jclinepi.com/article/S0895-4356(10)00330-6/abstract Accessed March 10, 2013
4. G.H. Guyatt, A.D. Oxman, G.E. Vist, R. Kunz, Y. Falck-Ytter, P. Alonso-Coello, and et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations BMJ 336 2008 924 926
5. Guidelines for WHO Guidelines (WHO) 2003. Version 10, 2003. EIP/GPE/EQC/2003.1.
6. S. Birch, J.L. Leake, and D. Lewis Economic issues in the development and use of practice guidelines: an application to resource allocation in dentistry Community Dental Health 13 1996 70 75
7. A. Granata, and A. Hillman Competing practice guidelines: using cost-effectiveness analysis to make optimal decisions Ann Intern Med 128 1998 56 63
8. GRADE Working Group. Available at http://www.gradeworkinggroup.org/. Accessed April 2, 2015.
9. H. Balshem, M. Helfand, H.J. Schünemann, A.D. Oxman, R. Kunz, J. Brozek, and et al. GRADE guidelines: 3. Rating the quality of evidence J Clin Epidemiol 64 2011 401 406
10. J.C. Andrews, H.J. Schünemann, A.D. Oxman, K. Pottie, J.J. Meerpohl, P.A. Coello, and et al. GRADE guidelines 15: going from evidence to recommendation-determinants of a recommendation's direction and strength J Clin Epidemiol 66 2013 726 735
11. WHO Guideline: Guidelines for the programmatic management of drug-resistant tuberculosis 2011 World Health Organization (WHO) Geneva Available at http://whqlibdoc.who.int/publications/2011/9789241501583-eng.pdf?ua=1 Accessed January 2013
12. S. Bhasin, G.R. Cunningham, F.J. Hayes, A.M. Matsumoto, P.J. Snyder, R.S. Swerdloff, and et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline J Clin Endocrinol Metab 95 2010 2536 2559
13. WHO Guideline: WHO guidelines for the management of postpartum haemorrhage and retained placenta 2009 World Health Organization (WHO) Geneva Available at http://whqlibdoc.who.int/publications/2009/9789241598514-eng.pdf Accessed January 2013
14. WHO Guideline: WHO recommendations for the prevention and treatment of postpartum haemorrhage 2012 World Health Organization (WHO) Geneva Available at http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502-eng.pdf Accessed January 2013
15. WHO Guideline: Rapid advice. Treatment of tuberculosis in children 2010 World Health Organization (WHO) Geneva Available at http://whqlibdoc.who.int/publications/2010/9789241500449-eng.pdf Accessed January 2013
16. P.E. Alexander, L. Bero, V.M. Montori, J.P. Brito, R. Stoltzfus, B. Djulbegovic, and et al. World Health Organization recommendations are often strong based on low confidence in effect estimates J Clin Epidemiol 67 2014 629 634
17. P.E. Alexander, J.P. Brito, I. Neumann, M.R. Gionfriddo, L. Bero, B. Djulbegovic, and et al. World Health Organization strong recommendations based on low quality evidence (study quality) are frequent and often inconsistent with GRADE guidance J Clin Epidemiol 2014 pii: S0895-4356(14)00417-X. http://dx.doi.org/10.1016/j.jclinepi.2014.10.011. [Epub ahead of print]
18. G.H. Guyatt, H.J. Schünemann, B. Djulbegovic, and E.A. Akl Guideline panels should not GRADE good practice statements J Clin Epidemiol 68 2015 597 600
19. J.P. Brito, J.P. Domecq, M.H. Murad, G.H. Guyatt, and V.M. Montori The endocrine society guidelines: when the confidence cart goes before the evidence horse J Clin Endocrinol Metab 98 2013 3246 3252
20. M. Sandelowski Whatever happened to qualitative description? Res Nurs Health 23 2000 334 340
21. M. Sandelowski Real qualitative researchers do not count: the use of numbers in qualitative research Res Nurs Health 24 2001 230 240
22. J.L. Walker The use of saturation in qualitative research Can J Cardiovasc Nurs 22 2 2012 37 46
23. S. Thorne, S. Reimer Kirkham, and K. O'Flynn-Magee The analytic challenge in interpretive description Int J Qual Methods 3 1 2004 Article 1. Available at http://www.ualberta.ca/~iiqm/backissues/3-1/pdf/thorneetal.pdf Accessed August 21, 2013
24. S. Kvale Interviews: an introduction to qualitative research interviewing 1996 SAGE Publications, Inc Thousand Oaks, CA
25. Y.S. Lincoln, and E.A. Guba Naturalistic inquiry 1985 Sage Newberry Park, Beverly Hills, CA
26. S. Sullivan-Bolyai, C. Bova, and D. Harper Developing and refining interventions in persons with health disparities: the use of qualitative description Nurs Outlook 53 2005 127 133
27. M.B. Miles, and A.M. Huberman Qualitative data analysis: a sourcebook of new methods 2nd ed. 1994 Sage Thousand Oaks, CA
28. H.F. Hsieh, and S.E. Shannon Three approaches to qualitative content analysis Qual Health Res 15 2005 1277 1288
29. D.J. Hruschka, D. Schwartz, D. Cobb St. John, E. Picone, R. Jenkins, and J. Carey Reliability in coding open-ended data: lessons learned from HIV behavioral research Field Methods 16 2004 307 331
30. A. Tong, P. Sainsbury, and J. Craig Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups Int J Qual Health Care 19 2007 349 357
31. CASP. International network on critical appraisal. Appraisal tools. Available at http://www.caspinternational.org/?o=1012. Accessed on November 26, 2014.
32. C. Barbui, T. Dua, M. van Ommeren, M.T. Yasamy, A. Fleischmann, N. Clark, and et al. Challenges in developing evidence-based recommendations using the GRADE approach: the case of mental, neurological, and substance use disorders PLos Med 7 2010 10.1371/journal.pmed.1000322
33. K. Pottie, S. Connor Gorber, H. Singh, M. Joffres, P. Lindsay, P. Brauer, and et al. Estimating benefits and harms of screening across subgroups: the Canadian Task Force on Preventive Health Care integrates the GRADE approach and overcomes minor challenges J Clin Epidemiol 65 2012 1245 1248
34. M.T. Ansari, A. Tsertsvadze, and D. Moher Grading quality of evidence and strength of recommendations: a perspective PLos Med 6 2009 e1000151
35. D. Sinclair, R. Isba, T. Kredo, B. Zani, H. Smith, and P. Garner World health organization guideline development: an evaluation PLoS One 8 2013 e63715
36. S.M. Umar Nasser, G. Cooke, K. Kranzer, S.L. Norris, P. Olliaro, and N. Ford Strength of WHO recommendations influences uptake in national guidelines: a systematic assessment J Clin Epidemiol 68 2015 703 707
37. Evidence to Decision (EtD) tables. Framework for clinical guidelines' development. Available at http://www.slideshare.net/CharlieNeck/etd-20140327. Accessed December 26, 2014.