high, moderate, low or very low based on these assessments. Methodologists summarized the quality of evidence assessment in evidence profile format using GDT software (www.GRADEPRO.org). Each evidence profile was reviewed in multiple steps by the primary question reviewer, all section members, and the vice chair and chair before being considered final. The process by which descriptive questions are addressed is described in the methods paper. 10. Evidence to Decision Framework and Recommendation Generation The Evidence to Decision (EtoD) framework was used to help organize discussion around each potential recommendation and ensure each of the following domains/components was considered : a. Priority of the problem. For the purpose of this guideline, all questions addressed important clinical problems. b. Magnitude of the desirable anticipated effects. The larger the desirable outcomes, the more inclined we were to recommend the intervention. c. Magnitude of the undesirable anticipated effects. The larger the undesirable consequences, the less inclined we were to recommend the intervention. d. Certainty of evidence. The higher the quality of evidence the more likely we were to issue a strong recommendation. e. Values and preferences. The more variability in values and preferences, or more uncertainty in values and preferences, the more likely we were to issue a conditional (i.e., weak) recommendation. f. Balance between desirable and undesirable effects. When desirable consequences (desirable treatment effect, consistency in values and preferences) clearly outweigh the undesirable consequences (undesirable treatment effect, large variability in values and preferences) or vice-versa, we were more inclined to issue a strong recommendation. When the balance was less clear or undetermined, then we were more inclined to issue a conditional recommendation or a neutral recommendation. g. Costs/resource allocation. The higher the costs of an intervention (that is, the more resources consumed) the less likely we were to issue a strong recommendation.
high, moderate, low or very low based on these assessments. Methodologists summarized the quality of evidence assessment in evidence profile format using GDT software (www.GRADEPRO.org). Each evidence profile was reviewed in multiple steps by the primary question reviewer, all section members, and the vice chair and chair before being considered final. The process by which descriptive questions are addressed is described in the methods paper. 10. Evidence to Decision Framework and Recommendation Generation The Evidence to Decision (EtoD) framework was used to help organize discussion around each potential recommendation and ensure each of the following domains/components was considered : a. Priority of the problem. For the purpose of this guideline, all questions addressed important clinical problems. b. Magnitude of the desirable anticipated effects. The larger the desirable outcomes, the more inclined we were to recommend the intervention. c. Magnitude of the undesirable anticipated effects. The larger the undesirable consequences, the less inclined we were to recommend the intervention. d. Certainty of evidence. The higher the quality of evidence the more likely we were to issue a strong recommendation. e. Values and preferences. The more variability in values and preferences, or more uncertainty in values and preferences, the more likely we were to issue a conditional (i.e., weak) recommendation. f. Balance between desirable and undesirable effects. When desirable consequences (desirable treatment effect, consistency in values and preferences) clearly outweigh the undesirable consequences (undesirable treatment effect, large variability in values and preferences) or vice-versa, we were more inclined to issue a strong recommendation. When the balance was less clear or undetermined, then we were more inclined to issue a conditional recommendation or a neutral recommendation. g. Costs/resource allocation. The higher the costs of an intervention (that is, the more resources consumed) the less likely we were to issue a strong recommendation.
CCM_46_9_2018_06_08_DEVLIN_CCMED-D-18-00069_SDC1.docx