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

• Published in: Journal of clinical epidemiology Vol. 129; pp. 1 - 11
• Main Authors: Akl, Elie A., Morgan, Rebecca L., Rooney, Andrew A., Beverly, Brandiese, Katikireddi, Srinivasa Vittal, Agarwal, Arnav, Alper, Brian S., Alva-Diaz, Carlos, Amato, Laura, Ansari, Mohammed T., Brozek, Jan, Chu, Derek K., Dahm, Philipp, Darzi, Andrea J., Falavigna, Maicon, Gartlehner, Gerald, Pardo-Hernandez, Hector, King, Valerie, Klugarová, Jitka, Langendam, M.W. Miranda, Lockwood, Craig, Mammen, Manoj, Mathioudakis, Alexander G., McCaul, Michael, Meerpohl, Joerg J., Minozzi, Silvia, Mustafa, Reem A., Nonino, Francesco, Piggott, Thomas, Qaseem, Amir, Riva, John, Rodin, Rachel, Sekercioglu, Nigar, Skoetz, Nicole, Traversy, Gregory, Thayer, Kris, Schünemann, Holger
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2021; Elsevier Limited; Published by Elsevier Inc
• Subjects: Adequacy; Conflicts of interest; Consensus; Coronaviruses; COVID-19; Epidemiology; Evaluation; Evidence-Based Medicine - standards; Evidence-Based Medicine - trends; GRADE; Humans; Information Management - methods; Information Management - organization & administration; Internal Medicine; Literature reviews; Logistics; Outcome Assessment, Health Care - methods; Outcome Assessment, Health Care - organization & administration; Pandemic; Pandemics; Practice Guidelines as Topic - standards; Public health; Risk assessment; Series; Systematic review; Systematic Reviews as Topic; Trustworthiness; Trustworthy guideline; Urgent recommendation; Working groups; Urgent recommendation; GRADE; Pandemic; Trustworthy guideline
• ISSN: 0895-4356; 1878-5921; 1878-5921
• DOI: 10.1016/j.jclinepi.2020.09.037

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. 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. 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. 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. •The proposed approach for developing trustworthy recommendations as part of urgent responses (1–2 week) builds on the general principles of trustworthy guideline development.•The approach proposes the following steps: (1) assess the level of urgency; (2) clarify and focus the scope of question(s); (3) prioritize and collect the information needed; (4) assess the adequacy of identified information; and then (5) develop recommendations;•Developing recommendations can consist of (1) adopting existing recommendations; (2) adapting existing recommendations; (3) developing new recommendations using existing systematic reviews; or (4) developing new recommendations using identified information and panel input.