COMPAR-EU Evidence to Decision frameworks (EtDs): a tool for stakeholders

One of these outputs are the Evidence to Decision (EtD) frameworks. Four COMPAR-EU panels used these frameworks to formulate recommendations about self-management interventions (SMIs) for patients living with Type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure. The project will make available these EtD frameworks as interactive tools to support healthcare professionals, patients, and policymakers, among others, to make informed decisions on the use and implementation of SMIs.

What are these frameworks all about?

EtD frameworks help panels use evidence in a structured and transparent way to make informed decisions in the context of clinical recommendations, coverage decisions, and health system or public health recommendations and decisions. The frameworks include key background information, criteria for making a decision, and a conclusion section.

The background section provides details of the question addressed, including the population, interventions, and main outcomes of interests, as well as the setting, and the perspective (individual or population perspective).

The criteria section includes all the important factors that should be considered for formulating the recommendation (e.g. desirable and undesirable effects, the certainty of evidence, how patients value outcomes, cost-effectiveness, or acceptability).

Illustration: Sarah Rosenbaum, Norwegian Institute of Public Health

The COMPAR-EU panels have made judgements about each criteria taking into consideration a synthesis of the best available research evidence, tabulated as Summary of Findings tables. Finally, taking into consideration all the judgements, they formulated 40 recommendations across conditions, and proposed implementation considerations and research priorities. Recommendations address both SMIs in general (versus usual care), several selected individual SMIs, defined according to their components (specific support techniques, type of providers, specific delivery methods, etc).

The panel judgments for each criterion and the recommendations were made during the more than 15 online meetings that have taken place, and online before meetings, using the Panel Voice extension from GRADEpro. Panel meetings included the presentation of the project, thorough discussions of the evidence from the systematic reviews conducted, and structured and transparent discussions, using the EtD frameworks.

How can stakeholders use the EtD frameworks?

The EtD frameworks are interactive tools to support decision-making on the use and implementation of SMIs, and as such, stakeholders, including clinicians, researchers, and policymakers, among others, can access these resources for the four conditions.

Clinicians will be able to review the frameworks in case they want to better understand the rationale of the recommendations, including the research evidence, additional considerations, and the judgments made by the panel. Furthermore, if relevant, they can use the decision aid module to inform and discuss with patients about their options (see previous blog on this topic). Researchers will be able to access previous research in a summarised format, and be aware of the gaps in current literature (detailed in the research priorities section) or the need of update of the research evidence. policymakers will also be able to review them and decide if they should adopt (use as described) or adapt a given recommendation to their setting.