In 2010, the Advisory Committee on Immunization Practice (ACIP) formally adopted the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for assessing the evidence and developing evidence-based recommendations. Since then, an assessment of the certainty of available evidence using GRADE has been an integral part of ACIP recommendation development. In addition to assessing the certainty of evidence, guideline panels consider other domains when making a recommendation (e.g., the balance of benefits and harms, patient’s values and preferences, etc.). This document presents the information that must be considered when making a recommendation. Previous documents/publications provide information on assessing the certainty of the evidence (Ahmed 2011).
During the process of recommendation formulation, panels consider a range of factors in addition to the certainty in the evidence. Elucidation of these factors and the judgments behind them facilitates transparency, consistency, and communication of recommendations to healthcare providers, partner organizations, and the public (Alonso-Cuello 2017a & b). To structure the discussion of these additional factors and to make the judgments transparent, an evidence to decision-making (EtD) framework is used.
The EtD structures decision-making by:
- Informing panel members’ judgments about the pros and cons of each intervention under consideration;
- Ensuring the important factors that determine a decision (criteria) are considered;
- Providing a concise summary of the best available evidence to inform judgements about each criterion;
- Helping structure discussion and identify reasons for disagreements when they occur; and
- Making the basis for decisions transparent to guideline users or those affected by a policy decision.
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