Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care.
J Clin Epidemiol
; 165: 111204, 2024 Jan.
Article
in En
| MEDLINE
| ID: mdl-37931823
ABSTRACT
OBJECTIVES:
To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics. STUDY DESIGN ANDSETTING:
Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience.RESULTS:
The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four 'conditional' recommendations.CONCLUSION:
The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Evidence-Based Medicine
/
Deprescriptions
Limits:
Humans
Language:
En
Journal:
J Clin Epidemiol
Journal subject:
EPIDEMIOLOGIA
Year:
2024
Document type:
Article