Development and application of health outcome descriptors facilitated decision-making in the production of practice guidelines

Wojtek Wiercioch, Robby Nieuwlaat, Philipp Dahm, Alfonso Iorio, Reem A. Mustafa, Ignacio Neumann, Bram Rochwerg, Veena Manja, Pablo Alonso-Coello, Thomas L. Ortel, Nancy Santesso, Sara K. Vesely, Elie A. Akl, Holger J. Schünemann, Neil Zakai, Adam Cuker, Wendy Lim, Paul Monagle, Robert Kunkle, Daniel M. WittSusan R. Kahn, Claire McLintock, Suely M. Rezende, Neil A. Zakai

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: Stakeholders involved in developing recommendations need to have a common understanding of health outcomes and the perspective of affected individuals. In this paper we report on the development and application of health outcome descriptors (HODs) to inform decision-making by panels developing guideline recommendations. Study Design and Setting: Ten American Society of Hematology guideline panels addressing the management of venous thromboembolism developed HODs, rated their importance and health utility, applied them to prioritize outcomes, and to balance potential benefits and harms to formulate recommendations. Results: It was feasible to involve 18 panelists in developing 127 HODs. There was high agreement (82%) across the ten panels about outcomes perceived as critical or important for decision-making. Panelists’ utility ratings of the outcomes were strongly correlated with panelists’ outcome importance ratings (Pearson's r=-0.88). HODs were incorporated into Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision (EtD) frameworks to support a shared understanding of health outcomes in panel deliberations. Conclusion: HODs serve as a valuable tool to promote an explicit, common understanding of health outcomes during clinical guideline development and across different stakeholders. They are helpful across multiple steps of guideline development to facilitate panels’ judgements, aiming to avoid variable implicit interpretations of health outcomes.

Original languageEnglish (US)
Pages (from-to)115-127
Number of pages13
JournalJournal of Clinical Epidemiology
Volume138
DOIs
StatePublished - Oct 2021
Externally publishedYes

Keywords

  • Clinical decision-making
  • Clinical practice guidelines
  • GRADE
  • Health outcomes
  • Health recommendations

ASJC Scopus subject areas

  • Epidemiology

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