Conrad Susann, Kaiser Laura, Kallenbach Maria, Meerpohl Jörg, Morche Johannes
Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland.
Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2019 Mar;140:63-73. doi: 10.1016/j.zefq.2019.02.006. Epub 2019 Mar 8.
Clinical guidelines are based on the best available evidence and produced systematically. In this context, the transparent presentation of the decision-making process from evidence to recommendation is indispensable. The Evidence to Decision (EtD) frameworks for clinical practice recommendations enables guideline panels to structure their approach and make it comprehensible. The EtD frameworks include three main sections: formulating the question, assessing the evidence and "Additional considerations" for each criterion, and drawing conclusions. This article focuses on the selection and operationalization of those criteria of the EtD framework that are relevant for clinical recommendations in guidelines. These include the priority of the problem, benefits and harms, certainty of the evidence, importance of the outcome, balance, resource use, equity, acceptability and feasibility. To make a recommendation, a panel must consider the implication and importance of each of the above judgments. The EtD framework helps ensure consideration of key criteria that determine whether an intervention should be recommended and that judgments are informed by the best available evidence.
临床指南基于现有最佳证据并系统制定。在此背景下,从证据到推荐的决策过程的透明呈现必不可少。临床实践推荐的证据到决策(EtD)框架使指南制定小组能够构建其方法并使其易于理解。EtD框架包括三个主要部分:提出问题、评估证据以及针对每个标准的“其他考虑因素”,并得出结论。本文重点关注EtD框架中与指南中的临床推荐相关的那些标准的选择和实施。这些标准包括问题的优先级、益处和危害、证据的确定性、结果的重要性、平衡、资源利用、公平性、可接受性和可行性。为了提出推荐意见,小组必须考虑上述每项判断的含义和重要性。EtD框架有助于确保考虑决定是否应推荐某项干预措施的关键标准,并确保判断以现有最佳证据为依据。