Published 31 July 2008, doi:10.1136/bmj.a744
Cite this as: BMJ 2008;337:a744

Analysis

Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive

¹ Department of Medicine, McMaster University, Hamilton, ON, Canada L8P 3B6, ² Department of Clinical Epidemiology and Biostatistics, McMaster University, ³ Division of Critical Care, Cooper University Hospital and Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Camden, NJ, USA, ⁴ Department of Epidemiology, Italian National Cancer Institute Rome, Rome 00144, Italy, ⁵ Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, RI, USA, ⁶ Basle Institute of Clinical Epidemiology, University Hospital Basle, 4031 Basle, Switzerland, ⁷ Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR 97239, USA, ⁸ University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH

The large and diverse nature of guideline committees can make consensus difficult. Roman Jaeschke and colleagues describe a simple technique for clarifying opinion

Guidelines have become an important vehicle for influencing clinical practice. Many local, national, and international societies now go through the process of identifying relevant clinical areas, formulating specific clinical questions, reviewing the applicable evidence, and formulating recommendations that they believe clinicians and their patients should follow.

Over the years, in recognition of the diversity of individuals required to produce optimal recommendations (content experts, methodologists, front line clinicians, patients’ representatives), guideline panels have grown in size. The resulting large and diverse panels present challenges for decision making, such as ensuring that all participants have a voice and can influence the results of the debate, ensuring transparency, dealing with disagreement, achieving consensus, and resolving situations in which consensus is not possible.

Guideline panels often use only informal processes to deal with these challenges. Informal processes are, however, vulnerable to the idiosyncrasies of small or moderate sized group interaction. Factors including time pressure; . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Guyatt, G. H., Helfand, M., Kunz, R. (2009). Comparing the USPSTF and GRADE Approaches to Recommendations. ANN INTERN MED 151: 363-363 [Full text]  
• Hahn, D. L. (2009). Importance of Evidence Grading for Guideline Implementation: The Example of Asthma. Ann Fam Med 7: 364-369 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Assessing evidence for guidelines and recommendations

Manfred Gogol
bmj.com, 20 Aug 2008 [Full text]