Table 1 Updates to language/format items after analysis of existing guidance tools
Subdomain (underlined) | Original content | Updated content | Source and justification |
|---|---|---|---|
Language CLEAR actionable/effective writing | Action item: Use words that convey the strength of recommendations (as per GRADE guidelines) | Action items: If using the GRADE approach: Identify recommendations according to their strength Use an action verb corresponding to the strength of a recommendation to operationalize it Employ consistent use of a letter, number, and/or symbol system for characterizing both the strength of a recommendation and the quality of evidence | Source: GRADE Handbook [13] Justification: authors’ consensus |
Language CLEAR consistent use of termsa | N/A | Action items: Use the same semantic indicators (use the same terminology to indicate level of evidence, strength of recommendation, and the action verbs) across recommendations When comparing alternative approaches, always frame the recommendations in favor of a particular management approach rather than against an alternative Reserve use of “not” for recommendations against a management approach that may be particularly harmful and/or widespread | Source: IOM [9] Justification: author consensus Source: GRADE Handbook [13] Justification: author consensus Source: GRADE Handbook [13] Justification: author consensus |
Format Presentation document structure | Action item: Ensure that the guideline has a clearly identifiable and optimal structure Operational definition: • Clear chunking (grouping) of information: Use sequential arrangement or bundling • Ensure standardized usage of formatting indicators such as type sizes and weights (e.g., bold) • Consider structuring by dividing patients into specific subclasses, if relevant | Action item: Ensure that the guideline has a clearly identifiable and optimal structure Operational definition: - Newly added components: • Group specific recommendations near the summary of key evidence for those recommendations • Consider using bold and/or underline to draw attention to all recommendations, or, if applicable, to a subset of recommendations pertaining to the main PICO question(s) covered by the guideline • Report recommendations in a way that is visible and easy to find (i.e. do not embed recommendations within long paragraphs, and consider grouping recommendations in a summary section). | Source: AGREE II [8] Justification: authors’ consensus Source: AGREE II [8], GLIA [3] Justification: found in more than one existing guidance document Source: IOM [9], GUIDELINES 2.0 [11], AGREE II [8] Justification: found in more than one existing guidance document |