GRADE guidelines: 15. Going from evidence to recommendation—determinants of a recommendation's direction and strength

Cochrane in CORR ®: Topical Application of Tranexamic Acid for the Reduction of Bleeding (Review)

“…In order to determine the direction and strength of a recommendation, guidelines panels should integrate confidence in the pooled effect estimates, the balance of desirable and undesirable outcomes among alternative management strategies, the values and preferences of typical patients, and the potential use of healthcare resources [1]. Given residual uncertainty about the risks for harm and potential variability in patients' preferences about trading off these risks against bleeding and blood transfusions, strong general recommendations may not be warranted.…”

Dissemination of Clinical Practice Guidelines

“…We developed a coding form and data abstraction sheet for manifest and latent content based on categories informed by the literature about patient education materials and research into disseminating guidelines and recommendations to practitioners [2,3,4,11]. Key components of the patient versions were extracted: format of the patient versions (e.g.…”

“…length, booklet), types of information provided (background, tests or treatments, evidence, recommendations, and additional information), the purpose of the patient versions, and communication of recommendations and evidence (see Supporting Information for the key components extracted and themes). We used the work from Dixon-Woods [3] to develop a list of the purposes of patient versions; we identified recommendations using the criteria outlined by Hussain [11]; identified important factors unique to guideline recommendations, such as patient values and preferences using the GRADE approach [2]; and used the themes found in the systematic review of patient and public attitudes towards CPGs (personalisation, credibility, purpose and format issues) [4]. Two investigators piloted the form using four patient versions and discussed results to check intercoder reliability and consistency, and then revised the form accordingly.…”

“…patients (including carers) and other members of the public. There is a wealth of information in CPGs, such as information about the effects of tests or treatments, the quality of that evidence, and clear recommendations which factor in patient values and preferences, resources, feasibility and other issues such as equity [2].…”

Guidelines helping clinicians make the GRADE

“…These elements, taken together, determine the direction of the recommendation that guideline developers make [12]. These factors, coupled with the quality of the evidence, inform both the direction and the strength of the recommendations made by the guideline panel [15].…”