Thoughts on the application of multi-criteria decision in the recommendation formation of clinical practice guideline_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Yicheng ^1,2,3 , XIA Ruyu ^1,2,3 , CAO Rui ^1,2,3 , TAO Liyuan ⁴ , CHAI Qianyun ^1,2,3 , LIU Zhihan ^1,2,3 , FENG Yuting ^1,2,3 , FANG Rui ⁵ , DENG Yingjie ⁵ , XIANG Wenyuan ⁵ ,  FEI Yutong ^1,2,3

1. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
2. Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
3. Beijing GRADE Center, Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
4. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, P. R. China;
5. Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi 830000, P. R. China;

Corresponding author：

FEI Yutong, Email: yutong_fei@163.com

Keywords：

Multi-criteria decision; Formation of recommendation; Methodology; Clinical practice guideline

DOI：

10.7507/1672-2531.202302127

Video：

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In the process of formation of recommendations of clinical practice guidelines, experts have many difficult problems of lack of transparency and high subjectivity in making final decisions, such as incomplete comprehensive consideration of dimensions and great heterogeneity in the evaluation of importance between dimensions, etc. As a decision-making tool, multi-criterion decision analysis improves the decision-making level of recommendation by adding the combination of qualitative and quantitative methods. By analyzing the challenges facing the formation of recommendations, this paper introduces the decision assistance of multi-criterion decision, and analyzes and summarizes the advantages and methods of the application of multi-criterion decision, so as to provide reference and guidance for guide makers to solve the difficulties in the formation of recommendations.

Citation： GAO Yicheng, XIA Ruyu, CAO Rui, TAO Liyuan, CHAI Qianyun, LIU Zhihan, FENG Yuting, FANG Rui, DENG Yingjie, XIANG Wenyuan, FEI Yutong. Thoughts on the application of multi-criteria decision in the recommendation formation of clinical practice guideline. Chinese Journal of Evidence-Based Medicine, 2023, 23(5): 616-620. doi: 10.7507/1672-2531.202302127 Copy

1.	张薇, 许吉, 邓宏勇. 国际医学证据分级与推荐体系发展及现状. 中国循证医学杂志, 2019, 19(11): 1373-1378.
2.	陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
3.	王云云, 靳英辉, 陈耀龙, 等. 循证临床实践指南推荐意见形成的方法分析. 中国循证医学杂志, 2017, 17(9): 1085-1092.
4.	赵国桢, 冯硕, 张霄潇, 等. 中医药临床实践指南: 现状和思考. 中国循证医学杂志, 2018, 18(12): 1386-1390.
5.	Schünemann HJ, Mustafa R, Brozek J, et al. GRADE guidelines: 16. GRADE evidence to decision frameworks for tests in clinical practice and public health. J Clin Epidemiol, 2016, 76: 89-98.
6.	Li SA, Alexander PE, Reljic T, et al. Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations. J Clin Epidemiol, 2018, 104: 103-112.
7.	Sanabria AJ, Kotzeva A, Selva Olid A, et al. Most guideline organizations lack explicit guidance in how to incorporate cost considerations. J Clin Epidemiol, 2019, 116: 72-83.
8.	Campbell B. Balancing the evidence for guidelines: lessons from the NICE abdominal aortic aneurysm guidance-an essay by Bruce Campbell. BMJ, 2020, 370: m3480.
9.	Djulbegovic B, Hozo I, Li SA, et al. Certainty of evidence and intervention's benefits and harms are key determinants of guidelines' recommendations. J Clin Epidemiol, 2021, 136: 1-9.
10.	Agoritsas T, Merglen A, Heen AF, et al. UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey. BMJ Open, 2017, 7(11): e018593.
11.	Yao L, Ahmed MM, Guyatt GH, et al. Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis. BMJ, 2021, 375: e066045.
12.	Spellberg B, Wright WF, Shaneyfelt T, et al. The future of medical guidelines: standardizing clinical care with the humility of uncertainty. Ann Intern Med, 2021, 174(12): 1740-1742.
13.	Keeney RL, Raiffa H. Decisions with multiple objectives: preferences and value tradeoffs. Cambridge: Cambridge University Press, 1993.
14.	Baltussen R, Niessen L. Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Resour Alloc, 2006, 4: 14.
15.	Marsh K, Lanitis T, Neasham D, et al. Assessing the value of healthcare interventions using multi-criteria decision analysis: a review of the literature. Pharmacoeconomics, 2014, 32(4): 345-365.
16.	陈晓炜, 陈钱, 耿劲松, 等. 多准则决策分析应用于医疗保险报销的系统评价. 中国卫生资源, 2018, 21(3): 218-223.
17.	Broekhuizen H, Groothuis-Oudshoorn CG, van Til JA, et al. A review and classification of approaches for dealing with uncertainty in multi-criteria decision analysis for healthcare decisions. Pharmacoeconomics, 2015, 33(5): 445-455.
18.	Marsh K, Goetghebeur M, Thokala P, et al. 多准则决策分析在卫生决策中的应用. 上海: 上海交通大学出版社, 2019.
19.	高一城, 夏如玉, 柴倩云, 等. 组建患者小组: 将患者价值观与偏好整合融入指南制订过程的建议. 协和医学杂志, 2022. DOI: 10.12290/xhyxzz.2022-0528.
20.	范曼如, 申泉, 王丹琦, 等. 临床实践指南制订方法—形成推荐意见的共识方法学. 中国循证心血管医学杂志, 2019, 11(6): 647-653.
21.	WHO. WHO handbook for guideline development (2_nd edition).
22.	The Joanna Briggs Institute Levels of Evidence and Grade of Recommendation Working Party. Supporting document for the Joanna Briggs Institute levels of evidence and grade of recommendation.
23.	SIGN. SIGN 50: a guideline developer’s handbook.
24.	Shekelle PG. Clinical practice guidelines: what's next. JAMA, 2018, 320(8): 757-758.
25.	Gopinathan U, Hoffman SJ. Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization. BMJ Glob Health, 2018, 3(5): e000716.
26.	Eccles MP, Grimshaw JM, Shekelle P, et al. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implement Sci, 2012, 7: 60.

1. 张薇, 许吉, 邓宏勇. 国际医学证据分级与推荐体系发展及现状. 中国循证医学杂志, 2019, 19(11): 1373-1378.
2. 陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
3. 王云云, 靳英辉, 陈耀龙, 等. 循证临床实践指南推荐意见形成的方法分析. 中国循证医学杂志, 2017, 17(9): 1085-1092.
4. 赵国桢, 冯硕, 张霄潇, 等. 中医药临床实践指南: 现状和思考. 中国循证医学杂志, 2018, 18(12): 1386-1390.
5. Schünemann HJ, Mustafa R, Brozek J, et al. GRADE guidelines: 16. GRADE evidence to decision frameworks for tests in clinical practice and public health. J Clin Epidemiol, 2016, 76: 89-98.
6. Li SA, Alexander PE, Reljic T, et al. Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations. J Clin Epidemiol, 2018, 104: 103-112.
7. Sanabria AJ, Kotzeva A, Selva Olid A, et al. Most guideline organizations lack explicit guidance in how to incorporate cost considerations. J Clin Epidemiol, 2019, 116: 72-83.
8. Campbell B. Balancing the evidence for guidelines: lessons from the NICE abdominal aortic aneurysm guidance-an essay by Bruce Campbell. BMJ, 2020, 370: m3480.
9. Djulbegovic B, Hozo I, Li SA, et al. Certainty of evidence and intervention's benefits and harms are key determinants of guidelines' recommendations. J Clin Epidemiol, 2021, 136: 1-9.
10. Agoritsas T, Merglen A, Heen AF, et al. UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey. BMJ Open, 2017, 7(11): e018593.
11. Yao L, Ahmed MM, Guyatt GH, et al. Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis. BMJ, 2021, 375: e066045.
12. Spellberg B, Wright WF, Shaneyfelt T, et al. The future of medical guidelines: standardizing clinical care with the humility of uncertainty. Ann Intern Med, 2021, 174(12): 1740-1742.
13. Keeney RL, Raiffa H. Decisions with multiple objectives: preferences and value tradeoffs. Cambridge: Cambridge University Press, 1993.
14. Baltussen R, Niessen L. Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Resour Alloc, 2006, 4: 14.
15. Marsh K, Lanitis T, Neasham D, et al. Assessing the value of healthcare interventions using multi-criteria decision analysis: a review of the literature. Pharmacoeconomics, 2014, 32(4): 345-365.
16. 陈晓炜, 陈钱, 耿劲松, 等. 多准则决策分析应用于医疗保险报销的系统评价. 中国卫生资源, 2018, 21(3): 218-223.
17. Broekhuizen H, Groothuis-Oudshoorn CG, van Til JA, et al. A review and classification of approaches for dealing with uncertainty in multi-criteria decision analysis for healthcare decisions. Pharmacoeconomics, 2015, 33(5): 445-455.
18. Marsh K, Goetghebeur M, Thokala P, et al. 多准则决策分析在卫生决策中的应用. 上海: 上海交通大学出版社, 2019.
19. 高一城, 夏如玉, 柴倩云, 等. 组建患者小组: 将患者价值观与偏好整合融入指南制订过程的建议. 协和医学杂志, 2022. DOI: 10.12290/xhyxzz.2022-0528.
20. 范曼如, 申泉, 王丹琦, 等. 临床实践指南制订方法—形成推荐意见的共识方法学. 中国循证心血管医学杂志, 2019, 11(6): 647-653.
21. WHO. WHO handbook for guideline development (2_nd edition).
22. The Joanna Briggs Institute Levels of Evidence and Grade of Recommendation Working Party. Supporting document for the Joanna Briggs Institute levels of evidence and grade of recommendation.
23. SIGN. SIGN 50: a guideline developer’s handbook.
24. Shekelle PG. Clinical practice guidelines: what's next. JAMA, 2018, 320(8): 757-758.
25. Gopinathan U, Hoffman SJ. Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization. BMJ Glob Health, 2018, 3(5): e000716.
26. Eccles MP, Grimshaw JM, Shekelle P, et al. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implement Sci, 2012, 7: 60.

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