Jaeschke R, Jankowski M, Brozek J, Antonelli M
Department of Medicine, McMaster University, Hamilton, ON, L8P 3B6, Canada.
Minerva Anestesiol. 2009 Sep;75(9):504-8. Epub 2008 Nov 11.
Recent decades have seen an explosion of clinical practice guidelines documents developed to inform clinicians about the best options for managing treatment, with the explicit intent to influence behaviour. As our exposure to guidelines has increased it has become clear that the process of guideline development should follow specific rules in order to avoid disagreement, misunderstanding, misleading recommendations, and confusion. In this article, we review the approach to developing clinical practice guidelines suggested by an international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) workgroup. This approach suggests several steps for guideline development: 1. determine the purpose, scope, and intended audience; 2. select the panel of guideline authors; 3. specify the main focused clinical questions that the recommendations will address; 4. decide on the relative importance of outcomes; 5. find and summarize the evidence supporting each recommendation; 6. determine the quality of the available evidence; 7. evaluate the balance of desirable and undesirable consequences for a particular course of action; 8. formulate recommendations, including their strenght; and 9. consider a system for subsequent guideline implementation and evaluation. We aim to help the readers of practice guidelines asses those guidelines' quality and validity, as well as to assist the authors of future guidelines in systematically generating clinical recommendations.
近几十年来，为了让临床医生了解治疗管理的最佳选择，从而明确影响其行为，临床实践指南文件大量涌现。随着我们接触指南的机会增多，很明显，指南制定过程应遵循特定规则，以避免分歧、误解、误导性建议和混淆。在本文中，我们回顾了国际推荐分级、评估、制定与评价（GRADE）工作组提出的临床实践指南制定方法。该方法为指南制定提出了几个步骤：1. 确定目的、范围和目标受众；2. 挑选指南作者小组；3. 明确推荐意见将解决的主要重点临床问题；4. 确定结果的相对重要性；5. 查找并总结支持每项推荐意见的证据；6. 确定现有证据的质量；7. 评估特定行动方案的利弊平衡；8. 制定推荐意见，包括其强度；9. 考虑后续指南实施和评估的系统。我们旨在帮助实践指南的读者评估这些指南的质量和有效性，同时协助未来指南的作者系统地生成临床推荐意见。
