Senerth Emily, Whaley Paul, Akl Elie, Beverly Brandy, Alonso-Coello Pablo, Rooney Andrew, Schünemann Holger J, Thayer Kristina A, Tsaioun Katya, Morgan Rebecca L
Department of Epidemiology, George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW #2, Washington, DC 20052, USA; Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205, USA.
Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205, USA; Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK.
Environ Int. 2025 Mar;197:109314. doi: 10.1016/j.envint.2025.109314. Epub 2025 Feb 1.
To provide guidance for the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision (EtD) framework for environmental and occupational health (EOH).
We conducted a systematic review and narrative synthesis of published and public EOH decision frameworks, followed by a modified Delphi process leading to development of a draft GRADE EtD framework for EOH. We pilot tested the provisional framework through a virtual workshop series, which further informed guidance for the framework's application. We presented a summary of the results to all attendees of the GRADE Working Group meeting for feedback in July 2022 and November 2022, and for approval in May 2023.
Consistent with existing GRADE EtD frameworks, the EtD framework for EOH includes a scoping and contextualization process and twelve assessment criteria. Modifications to the existing EtD frameworks include: consideration of the socio-political context when making judgments about the priority of the problem and feasibility of different alternatives; the addition of timing when making judgments about benefits and harms, the balance of effects, and feasibility; broadening of the equity criterion to include considerations beyond health equity; and more explicit accommodation of variable or conflicting stakeholder views when considering values and acceptability. The new EtD framework is also accompanied by a user guide intended to support its implementation in the EOH context.
Policymakers, regulators, and other stakeholders may use this GRADE EtD framework to approach decision-making about environmental and occupational exposures and interventions.
为环境与职业健康（EOH）领域使用推荐分级评估、制定与评价（GRADE）证据到决策（EtD）框架提供指导。
我们对已发表和公开的EOH决策框架进行了系统回顾和叙述性综合分析，随后通过改进的德尔菲法制定了EOH的GRADE EtD框架草案。我们通过一系列虚拟研讨会对临时框架进行了试点测试，这进一步为框架的应用提供了指导。我们于2022年7月和11月向GRADE工作组会议的所有与会者介绍了结果以征求反馈意见，并于2023年5月征求批准。
与现有的GRADE EtD框架一致，EOH的EtD框架包括一个范围界定和背景化过程以及十二个评估标准。对现有EtD框架的修改包括：在判断问题的优先级和不同替代方案的可行性时考虑社会政治背景；在判断益处和危害、效果平衡及可行性时增加时间因素；将公平标准扩大到包括健康公平之外的考虑因素；以及在考虑价值观和可接受性时更明确地考虑利益相关者的不同或冲突观点。新的EtD框架还附带了一份用户指南，旨在支持其在EOH背景下的实施。
政策制定者、监管机构和其他利益相关者可使用此GRADE EtD框架来进行有关环境和职业暴露及干预措施的决策。
