Decision making about healthcare-related tests and diagnostic test strategies. Paper 5: a qualitative study with experts suggests that test accuracy data alone is rarely sufficient for decision making

Mustafa, Reem A.; Wiercioch, Wojtek; Ventresca, Matthew; Brožek, Jan; Bell, Hanan; Bettmann, Michael A.; Bossuyt, Patrick M.; Browman, George P.; Bühler, Diedrich; Chou, Roger; Don-Wauchope, Andrew; Elwyn, Glyn; Garg, Amit X.; Ghersi, Davina; Gion, Massimo; Glasziou, Paul; Horvath, Andrea R.; Kopp, I.; Krahn, Murray; Leipzig, Rosanne M.; Lelgemann, Monika; Lloyd, Nancy; Mākelä, Marjukka; Mendelson, Richard; Mujoomdar, Michelle; Reed, Martin H.; Remedios, D.; Sauerland, Stefan; Saijonkari, Maija; Steingart, Karen R; Tan, Toni; Qaseem, Amir

doi:10.1016/j.jclinepi.2017.09.005

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…12,[24][25][26] However, this approach typically addresses a framework to support decision-making when data based on direct comparison are lacking but test accuracy results are available. 12,27 During review of the body of evidence informing screening questions, it became evident that test accuracy results either are lacking or, when available, have serious limitations hindering the panel's ability to make judgments. Consequently, the systematic review team identified any other data that could potentially support developing recommendations.…”

Section: Methodological Considerations For Screening Questionsmentioning

confidence: 99%

American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

et al. 2019

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Background: Prevention and management of end-organ disease represent major challenges facing providers of children and adults with sickle cell disease (SCD). Uncertainty and variability in the screening, diagnosis, and management of cardiopulmonary and renal complications in SCD lead to varying outcomes for affected individuals. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. Methods: ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including performing systematic evidence reviews up to September 2017. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 10 recommendations for screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. Recommendations related to anticoagulation duration for adults with SCD and venous thromboembolism were also developed. Conclusions: Most recommendations were conditional due to a paucity of direct, high-quality evidence for outcomes of interest. Future research was identified, including the need for prospective studies to better understand the natural history of cardiopulmonary and renal disease, their relationship to patient-important outcomes, and optimal management.

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Section: Methodological Considerations For Screening Questionsmentioning

confidence: 99%

American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

et al. 2019

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“…[16][17][18][19] However, this approach addressed decision making when only diagnostic studies were available (ie, data were available on test accuracy results and not on health outcomes) and not specifically for screening. 19,20 To allow for consistent decisions among the different screening questions, we developed a framework that supported developing recommendations based on multiple domains that can justify screening. This framework was informed by criteria proposed in 1968 to the World Health Organization by Wilson and Jungner, the US Preventive Services Taskforce manual, the GRADE diagnosis Evidence to Decision framework, and other literature about screening tests.…”

Section: Making Decisions About Screeningmentioning

confidence: 99%

2019 sickle cell disease guidelines by the American Society of Hematology: methodology, challenges, and innovations

et al. 2019

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The American Society of Hematology (ASH) convened 5 guideline panels to develop clinical practice recommendations addressing 5 management areas of highest importance to individuals living with sickle cell disease: pain, cerebrovascular complications, pulmonary and kidney complications, transfusion, and hematopoietic stem cell transplant. Panels were multidisciplinary and consisted of patient representatives, content experts, and methodologists. The Mayo Clinic Evidence-Based Practice Center conducted systematic reviews based on a priori selected questions. In this exposition, we describe the process used by ASH, including the GRADE approach (Grades of Recommendations, Assessment, Development and Evaluation) for rating certainty of the evidence and the GRADE Evidence to Decision Framework. We also describe several unique challenges faced by the guideline panels and the specific innovations and solutions used to address them, including a curriculum to train patients to engage in guideline development, dealing with the opioid crisis, and working with indirect and noncomparative evidence.

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“…The null can be a reasonable threshold for guidelines, if one index test has both superior sensitivity and specificity compared to the alternative test, and there are no disadvantages in using that test in terms of direct harms, cost, feasibility and other considerations relative to the comparison test. 3,4,23…”

Section: Box 2 Comparative Measures Of Test Accuracymentioning

confidence: 99%

GRADE Guidance: 31. Assessing the certainty across a body of evidence for comparative test accuracy

Yang

Mustafa

Bossuyt

et al. 2021

Journal of Clinical Epidemiology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Decision making about healthcare-related tests and diagnostic test strategies. Paper 5: a qualitative study with experts suggests that test accuracy data alone is rarely sufficient for decision making

Cited by 12 publications

References 18 publications

American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease

2019 sickle cell disease guidelines by the American Society of Hematology: methodology, challenges, and innovations

GRADE Guidance: 31. Assessing the certainty across a body of evidence for comparative test accuracy

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