Background: Judgments underlying guideline recommendations are seldom recorded and presented in a
systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report
guideline developers’ judgments. In this paper, we report the experiences with the EtD frameworks in 15 real
guideline panels.
Methods: Following the guideline panel meetings, we asked methodologists participating in the panel to provide
feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback
collected from the rest of the panel. Two investigators independently summarized the responses and jointly
interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results
and provide further input to improve the structure of the EtDs iteratively.
Results: The EtD framework was well received, and the comments were generally positive. Methodologists felt that
in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in
an explicit and transparent way. However, some sections (e.g., “values and preferences” and “balance between
benefits and harms”) required further development and clarification that were considered in the current version of
the EtD framework.
Conclusions: The use of an EtD framework in guideline development offers a structured and explicit way to record
and report the judgments and discussion of guideline panels during the formulation of recommendations. In
addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in
research.