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COVID-19 Series
Developing trustworthy recommendations as part of an urgent response (1–2 weeks): a GRADE concept paper

https://doi.org/10.1016/j.jclinepi.2020.09.037Get rights and content
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Highlights

  • The proposed approach for developing trustworthy recommendations as part of urgent responses (1–2 week) builds on the general principles of trustworthy guideline development.

  • The approach proposes the following steps: (1) assess the level of urgency; (2) clarify and focus the scope of question(s); (3) prioritize and collect the information needed; (4) assess the adequacy of identified information; and then (5) develop recommendations;

  • Developing recommendations can consist of (1) adopting existing recommendations; (2) adapting existing recommendations; (3) developing new recommendations using existing systematic reviews; or (4) developing new recommendations using identified information and panel input.

Abstract

Objectives

The aim of this study is to propose an approach for developing trustworthy recommendations as part of urgent responses (1–2 week) in the clinical, public health, and health systems fields.

Study Design and Setting

We conducted a review of the literature, outlined a draft approach, refined the concept through iterative discussions, a workshop by the Grading of Recommendations Assessment, Development and Evaluation Rapid Guidelines project group, and obtained feedback from the larger Grading of Recommendations Assessment, Development and Evaluation working group.

Results

A request for developing recommendations within 2 week is the usual trigger for an urgent response. Although the approach builds on the general principles of trustworthy guideline development, we highlight the following steps: (1) assess the level of urgency; (2) assess feasibility; (3) set up the organizational logistics; (4) specify the question(s); (5) collect the information needed; (6) assess the adequacy of identified information; (7) develop the recommendations using one of the 4 potential approaches: adopt existing recommendations, adapt existing recommendations, develop new recommendations using existing adequate systematic review, or develop new recommendations using expert panel input; and (8) consider an updating plan.

Conclusion

An urgent response for developing recommendations requires building a cohesive, skilled, and highly motivated multidisciplinary team with the necessary clinical, scientific, and methodological expertise; adapting to shifting needs; complying with the principles of transparency; and properly managing conflicts of interest.

Keywords

GRADE
Urgent recommendation
Pandemic
Trustworthy guideline

Cited by (0)

Funding: None.

Contributions: Elie Akl, Rebecca L. Morgan, Andrew Rooney, Kris Thayer, and Holger Schünemann conceived and designed the study. All authors contributed to the discussion of the concepts included in the paper. Elie Akl drafted the first version of the paper with initial input from Rebecca L. Morgan, Andrew Rooney, Brandiese Beverly, Srinivasa V. Katikireddi, Kris Thayer, and Holger Schünemann. All authors reviewed and approved the final version of the paper.

Conflicts of interest: None of the authors reported a relevant conflict of interest.

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