Senior GRADE methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis
Senior GRADE methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis
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DOI：
10.1016/j.jclinepi.2015.09.003
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发表时间：
2016-02-01
影响因子：
7.2
通讯作者：
Guyatt, Gordon H.
中科院分区：
文献类型：
--
作者：
Alexander, Paul E.;Li, Shelly-Anne;Guyatt, Gordon H.
背景资料：世界卫生组织（世卫组织）将其建议中的很大一部分归类为强有力的，尽管对效果估计的置信度很低或非常低（确定性）。这些不一致的建议通常与建议评估、制定和评价分级（GRADE）指南不一致。目的：了解世卫组织高级方法学主席对专家组使用GRADE的看法，特别是关于不一致建议的看法。数据来源：曾在至少两个世卫组织专家组任职并是至少一个同行的作者的高级活跃GRADE方法学家-方法：五名合格的方法学家参加了详细的半结构化访谈。受访者回答了其他小组成员和世卫组织领导层如何看待他们的问题，以及当小组成员提出他们认为不适当的不一致建议时，他们如何处理的问题。他们还介绍了如何改进这一进程。访谈记录和转录，归纳内容分析被用来获得代码，类别，和紧急themes.Results：三个主题出现在五个方法学家的访谈：（1）在这个过程中的方法学家的感知作用，（2）贡献者不和谐的建议，（3）改进策略。突出的发现包括（1）由于专家组成员抵制遵守GRADE指南，方法学家和世卫组织专家组之间存在明显的紧张关系;（2）专家组成员之间存在财务和非财务利益冲突，这是不一致建议的一种解释;（3）需要进一步明确方法学家作为专家组联合主席的作用，并给予支持。这些发现表明，GRADE方法学家作为共同主席的作用需要由世卫组织领导层加以澄清。他们进一步建议，需要对小组成员进行额外培训，进行质量监测和反馈，以确保WHO在指南制定中最佳使用GRADE。(C)2016 Elsevier Inc. All rights reserved.
Background: The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance.Objective: To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly regarding discordant recommendations.Data sources: Senior active GRADE methodologists who had served on at least two WHO panels and were an author on at least one peer-reviewed published article on GRADE methodology.Methods: Five eligible methodologists participated in detailed semistructured interviews. Respondents answered questions regarding how they were viewed by other panelists and WHO leadership, and how they handled situations when panelists made discordant recommendations they felt were inappropriate. They also provided information on how the process can be improved. Interviews were recorded and transcribed, and inductive content analysis was used to derive codes, categories, and emergent themes.Results: Three themes emerged from the interviews of five methodologists: (1) The perceived role of methodologists in the process, (2) Contributors to discordant recommendations, and (3) Strategies for improvement. Salient findings included (1) a perceived tension between methodologists and WHO panels as a result of panel members' resistance to adhering to GRADE guidance; (2) both financial and nonfinancial conflicts of interest among panel members as an explanation for discordant recommendations; and (3) the need for greater clarity of, and support for, the role of methodologists as co-chairs of panels.Conclusions: These findings suggest that the role of the GRADE methodologist as a co-chair needs to be clarified by the WHO leadership. They further suggest the need for additional training for panelists, quality monitoring, and feedback to ensure optimal use of GRADE in guideline development at WHO. (C) 2016 Elsevier Inc. All rights reserved.