Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada.
Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada.
J Clin Epidemiol. 2024 Nov;175:111483. doi: 10.1016/j.jclinepi.2024.111483. Epub 2024 Jul 31.
Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT is widely applied to efficiently use existing credible guidelines and contextualize them to a target setting. To highlight the experiences of a Latin American Guideline Development Group (GDG) applying GRADE-ADOLOPMENT to adapt the American Society of Hematology's clinical practice guideline on managing venous thromboembolisms (VTEs) in Latin America.
We employed a mixed-method postevaluation using self-administered surveys and semistructured interviews. We assessed the Latin American GDG (1) general satisfaction and confidence using the approach, (2) their ratings on the usefulness, appropriateness, and importance of GRADE-ADOLOPMENT and its tools to inform their judgements, and (3) any additional facilitators and barriers to refine the process.
Eleven of the 14 GDG members, including nine panelists and two methodologists, provided survey responses and eight participated in the interview. Respondents felt "mostly" or "completely" satisfied with the adapted guideline. Eight panelists who were surveyed agree that GRADE-ADOLOPMENT is useful in countries with limited resources. Although panelists expressed initial apprehensions in their understanding of the process, they demonstrated enhanced confidence in their capacity to apply GRADE after completing workshop training and by acquiring experience. Panelists reiterated the importance of considering evidence-to-decision (EtD) criteria (ie, resources, feasibility, and cost-effectiveness) when adapting recommendations. The GDG encountered challenges with collecting local and regional data, prioritizing recommendations while considering intraregional diversity, and the lengthy publication period, although the latter stemmed from procedures not related to GRADE-ADOLOPMENT.
GRADE-ADOLOPMENT is an important tool to facilitate the adaptation and uptake of clinical practice guidelines in novel settings. The GDG felt satisfied with their overall experience using the GRADE-ADOLOPMENT approach. However, their experience could have been optimized if they had access to robust regional evidence, more recommendations to adapt from, and worked with more efficient guideline production timelines.
推荐分级评估、制定与评价（GRADE）-ADOLPMENT 被广泛应用于有效地利用现有可信指南，并将其适用于目标环境。本研究旨在突显一个拉丁美洲指南制定小组（GDG）在应用 GRADE-ADOLPMENT 来改编美国血液病学会关于拉丁美洲静脉血栓栓塞症（VTE）管理的临床实践指南方面的经验。
我们采用了一种混合方法的后评价，使用自我管理的调查和半结构化访谈。我们评估了拉丁美洲 GDG（1）对该方法的总体满意度和信心，（2）他们对 GRADE-ADOLPMENT 的有用性、适当性和重要性的评价，以及其工具对他们判断的影响，以及（3）任何进一步的促进和障碍因素，以完善该过程。
14 名 GDG 成员中的 11 名，包括 9 名小组成员和 2 名方法学家，提供了调查答复，其中 8 名参加了访谈。受访者对改编后的指南表示“大部分”或“完全”满意。接受调查的 8 名小组成员认为，在资源有限的国家，GRADE-ADOLPMENT 是有用的。尽管小组成员在理解该过程时最初表示担忧，但他们在完成研讨会培训和获得经验后，对应用 GRADE 的能力表现出了更大的信心。小组成员重申了在改编建议时考虑证据决策（EtD）标准（即资源、可行性和成本效益）的重要性。GDG 在收集本地和区域数据、在考虑区域内多样性的同时优先考虑建议以及冗长的出版周期方面遇到了挑战，尽管后者源于与 GRADE-ADOLPMENT 无关的程序。
GRADE-ADOLPMENT 是促进在新环境中改编和采用临床实践指南的重要工具。GDG 对他们使用 GRADE-ADOLPMENT 方法的总体经验感到满意。然而，如果他们能够获得更有力的区域证据、更多的建议供改编以及更高效的指南制定时间表，他们的经验可能会得到优化。
