Improving GRADE evidence tables part 3: detailed guidance for explanatory footnotes supports creating and understanding GRADE certainty in the evidence judgments

Nancy Santesso; Alonso Carrasco-Labra; Miranda Langendam; Romina Brignardello-Petersen; Reem A Mustafa; Pauline Heus; Toby Lasserson; Newton Opiyo; Ilkka Kunnamo; David Sinclair; Paul Garner; Shaun Treweek; David Tovey; Elie A Akl; Peter Tugwell; Jan L Brozek; Gordon Guyatt; Holger J Schünemann

doi:10.1016/j.jclinepi.2015.12.006

Improving GRADE evidence tables part 3: detailed guidance for explanatory footnotes supports creating and understanding GRADE certainty in the evidence judgments

J Clin Epidemiol. 2016 Jun:74:28-39. doi: 10.1016/j.jclinepi.2015.12.006. Epub 2016 Jan 12.

Authors

Nancy Santesso¹, Alonso Carrasco-Labra², Miranda Langendam³, Romina Brignardello-Petersen⁴, Reem A Mustafa⁵, Pauline Heus⁶, Toby Lasserson⁷, Newton Opiyo⁷, Ilkka Kunnamo⁸, David Sinclair⁹, Paul Garner¹⁰, Shaun Treweek¹¹, David Tovey⁷, Elie A Akl¹², Peter Tugwell¹³, Jan L Brozek¹⁴, Gordon Guyatt¹⁴, Holger J Schünemann¹⁵

Affiliations

¹ Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
² Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Independencia, Santiago, Chile.
³ Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, PO Box 22660, J1B-211, 1100 DD Amsterdam, The Netherlands.
⁴ Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone Pohlhammer 943, Independencia, Santiago, Chile; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Department of Medicine/Nephrology, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA.
⁵ Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine/Nephrology, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA; Department of Biomedical & Health Informatics, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108-2792, USA.
⁶ Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer Street 6.131, Postbus 85500, 3508 GA Utrecht, The Netherlands.
⁷ Cochrane Editorial Unit, St Albans House, 57-59 Haymarket, London SW1Y 4QX, UK.
⁸ Department of General Practice and Primary Health Care, Duodecim Medical Publications Ltd and University of Helsinki, PO Box 874, Kaivokatu 10 A, 7th Floor, FIN-00101 Helsinki, Finland.
⁹ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
¹⁰ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK; Cochrane Infectious Diseases Group, Pembroke Place, Liverpool L3 5QA, UK.
¹¹ Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
¹² Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, Riad-El-Solh, PO Box 11-0236, Beirut 1107 2020, Lebanon.
¹³ Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada.
¹⁴ Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
¹⁵ Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Cochrane GRADEing Methods Group, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; McMaster GRADE Center, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Electronic address: schuneh@mcmaster.ca.

PMID: 26796947
DOI: 10.1016/j.jclinepi.2015.12.006

Abstract

Background: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is widely used and reliable and accurate for assessing the certainty in the body of health evidence. The GRADE working group has provided detailed guidance for assessing the certainty in the body of evidence in systematic reviews and health technology assessments (HTAs) and how to grade the strength of health recommendations. However, there is limited advice regarding how to maximize transparency of these judgments, in particular through explanatory footnotes or explanations in Summary of Findings tables and Evidence Profiles (GRADE evidence tables).

Methods: We conducted this study to define the essential attributes of useful explanations and to develop specific guidance for explanations associated with GRADE evidence tables. We used a sample of explanations according to their complexity, type of judgment involved, and appropriateness from a database of published GRADE evidence tables in Cochrane reviews and World Health Organization guidelines. We used an iterative process and group consensus to determine the attributes and develop guidance.

Results: Explanations in GRADE evidence tables should be concise, informative, relevant, easy to understand, and accurate. We provide general and domain-specific guidance to assist authors with achieving these desirable attributes in their explanations associated with GRADE evidence tables.

Conclusions: Adhering to the general and GRADE domain-specific guidance should improve the quality of explanations associated with GRADE evidence tables, assist authors of systematic reviews, HTA reports, or guidelines with information that they can use in other parts of their evidence synthesis. This guidance will also support editorial evaluation of evidence syntheses using GRADE and provide a minimum quality standard of judgments across tables.

Keywords: Evidence Profile; Explanations; GRADE; GRADEpro; Guidelines; Levels of evidence; Summary of Findings table; Systematic reviews.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Evidence-Based Medicine
Female
Humans
Information Dissemination / methods*
Judgment*
Male
Middle Aged
Research Report / standards*
Review Literature as Topic*
Technology Assessment, Biomedical
Uncertainty*
Young Adult

Grants and funding

HSRU2/CSO_/Chief Scientist Office/United Kingdom