Abstract
PRIMARY TRACK
Guideline development
SECONDARY TRACK
Guideline development methods
BACKGROUND (INTRODUCTION)
Lower Urinary Tract Symptoms (LUTS) in men is one of the first official clinical guidelines developed by NICE to pilot using elements of GRADE. NICE had previously used the SIGN system of assessing the quality of evidence and the guideline development groups (GDG) were less familiar with this new approach.
PURPOSE
To discuss the experiences and challenges of presenting this new method of evaluating evidence to the LUTS GDG.
LEARNING OBJECTIVES (TRAINING GOALS)
Identify and assess different methods of presenting GRADE to the guideline group. Understand the importance of a close collaboration between the technical team and guideline group.
METHODS
Results of systematic reviews were presented to the GDG using a modified GRADE approach to develop recommendations for the guideline. We trialed a combination of different methods of presenting these results with GRADE to determine the best approach for our GDG made up of clinicians and patient representatives.
RESULTS
We found the most accepted approach to presenting GRADE was to include extensive details of the criteria (study quality, imprecision, inconsistency, and indirectness) considered when rating outcomes. Techniques we used included presenting study limitations using a traffic light system from Review Manager 5.0 to visually highlight the risks of bias for each study. Confidence intervals, minimal important differences, and optimal information size values were presented in a decision table to determine whether outcomes were imprecise. GRADE's definitions of quality were also provided to the GDG to illustrate the difference between the GRADE and SIGN systems. We adapted the way we presented the results to ensure that the methods used to assess evidence quality were transparent and supported by the GDG.
DISCUSSION (CONCLUSION)
It is critical that the right level of detail is presented to the GDG so that they understand and support the quality rating and are comfortable making decisions and recommendations.
TARGET AUDIENCE(S)
Clinical researcher Evidence synthesizer, developer of systematic reviews or meta-analyses Guideline developer Guideline implementer Developer of guideline-based products