Editor's Choice - European Society for Vascular Surgery Clinical Practice Guideline Development Scheme: An Overview of Evidence Quality Assessment Methods, Evidence to Decision Frameworks, and Reporting Standards in Guideline Development

George A Antoniou; Frederico Bastos Gonçalves; Martin Björck; Nabil Chakfé; Raphaël Coscas; Nuno V Dias; Florian Dick; Stavros K Kakkos; Barend M E Mees; Timothy Resch; Santi Trimarchi; Riikka Tulamo; Chris P Twine; Frank Vermassen; Anders Wanhainen; Philippe Kolh

doi:10.1016/j.ejvs.2022.03.014

Editor's Choice - European Society for Vascular Surgery Clinical Practice Guideline Development Scheme: An Overview of Evidence Quality Assessment Methods, Evidence to Decision Frameworks, and Reporting Standards in Guideline Development

Eur J Vasc Endovasc Surg. 2022 Jun;63(6):791-799. doi: 10.1016/j.ejvs.2022.03.014. Epub 2022 Mar 22.

Authors

George A Antoniou¹, Frederico Bastos Gonçalves², Martin Björck³, Nabil Chakfé⁴, Raphaël Coscas⁵, Nuno V Dias⁶, Florian Dick⁷, Stavros K Kakkos⁸, Barend M E Mees⁹, Timothy Resch¹⁰, Santi Trimarchi¹¹, Riikka Tulamo¹², Chris P Twine¹³, Frank Vermassen¹⁴, Anders Wanhainen¹⁵, Philippe Kolh¹⁶

Affiliations

¹ Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. Electronic address: [email protected].
² Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Portugal.
³ Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden.
⁴ Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
⁵ Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
⁶ Vascular Centre, Skåne University Hospital, Malmö, Sweden.
⁷ Department of Vascular Surgery, Kantonsspital St. Gallen, University of Bern, Bern, Switzerland.
⁸ Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
⁹ Department of Vascular Surgery, Maastricht University Medical Centre and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
¹⁰ Department of Vascular Surgery, Copenhagen University Hospital- Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹¹ Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
¹² Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹³ Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK; Centre for Surgical Research, University of Bristol, Bristol, UK.
¹⁴ Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
¹⁵ Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden; Department of Surgery and Peri-operative Sciences, Umeå University, Umeå, Sweden.
¹⁶ Department of Biomedical and Preclinical Sciences, University of Liège, Belgium; GIGA Cardiovascular Sciences, University of Liège, Belgium; Department of Information System Management, University Hospital of Liège, Belgium.

PMID: 35697645
DOI: 10.1016/j.ejvs.2022.03.014

Abstract

Objective: A structured and transparent approach is instrumental in translating research evidence to health recommendations and evidence informed clinical decisions. The aim was to conduct an overview and analysis of principles and methodologies for health guideline development.

Methods: A literature review on methodologies, strategies, and fundamental steps in the process of guideline development was performed. The clinical practice guideline development process and methodology adopted by the European Society for Vascular Surgery are also presented.

Results: Sophisticated methodologies for health guideline development are being applied increasingly by national and international organisations. Their overarching principle is a systematic, structured, transparent, and iterative process that is aimed at making well informed healthcare choices. Critical steps in guideline development include the assessment of the certainty of the body of evidence; evidence to decision frameworks; and guideline reporting. The goal of strength of evidence assessments is to provide well reasoned judgements about the guideline developers' confidence in study findings, and several evidence hierarchy schemes and evidence rating systems have been described for this purpose. Evidence to decision frameworks help guideline developers and users conceptualise and interpret the construct of the quality of the body of evidence. The most widely used evidence to decision frameworks are those developed by the GRADE Working Group and the WHO-INTEGRATE, and are structured into three distinct components: background; assessment; and conclusions. Health guideline reporting tools are employed to ensure methodological rigour and transparency in guideline development. Such reporting instruments include the AGREE II and RIGHT, with the former being used for guideline development and appraisal, as well as reporting.

Conclusion: This guide will help guideline developers/expert panels enhance their methodology, and patients/clinicians/policymakers interpret guideline recommendations and put them in context. This document may be a useful methodological summary for health guideline development by other societies and organisations.

Keywords: AGREE; Certainty of evidence; Clinical practice guidelines; Evidence to decision framework; GRADE; Quality of evidence.

Publication types

Review