GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT

Holger J. Schünemann, Wojtek Wiercioch, Jan Brozek, Itziar Etxeandia-Ikobaltzeta, Reem A. Mustafa, Veena Manja, Romina Brignardello-Petersen, Ignacio Neumann, Maicon Falavigna, Waleed Alhazzani, Nancy Santesso, Yuan Zhang, Jörg J. Meerpohl, Rebecca L. Morgan, Bram Rochwerg, Andrea Darzi, Maria Ximenas Rojas, Alonso Carrasco-Labra, Yaser Adi, Zulfa AlRayeesJohn Riva, Claudia Bollig, Ainsley Moore, Juan José Yepes-Nuñez, Carlos Cuello, Reem Waziry, Elie A. Akl

Research output: Contribution to journalArticlepeer-review

215 Scopus citations


Background Guideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. Objectives To describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks. Study Design and Setting We applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations. Results We produced a total of 80 EtD frameworks in approximately 4 months and 146 EtDs in approximately 6 months in two waves. Use of the EtD frameworks allowed panel members understand judgments of others about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach. Conclusion The “GRADE-ADOLOPMENT” approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If developers of guidelines follow EtD criteria more widely and make their work publically available, this approach should prove even more useful.

Original languageEnglish (US)
Pages (from-to)101-110
Number of pages10
JournalJournal of Clinical Epidemiology
StatePublished - Jan 1 2017
Externally publishedYes


  • Adaptation
  • Clinical practice guidelines
  • Evidence to Decision framework
  • Evidence-based medicine
  • Recommendation

ASJC Scopus subject areas

  • Epidemiology


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