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

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2.	陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
3.	王云云, 靳英輝, 陳耀龍, 等. 循證臨床實踐指南推薦意見形成的方法分析. 中國循證醫學雜志, 2017, 17(9): 1085-1092.
4.	趙國楨, 馮碩, 張霄瀟, 等. 中醫藥臨床實踐指南: 現狀和思考. 中國循證醫學雜志, 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.	陳曉煒, 陳錢, 耿勁松, 等. 多準則決策分析應用于醫療保險報銷的系統評價. 中國衛生資源, 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. 多準則決策分析在衛生決策中的應用. 上海: 上海交通大學出版社, 2019.
19.	高一城, 夏如玉, 柴倩云, 等. 組建患者小組: 將患者價值觀與偏好整合融入指南制訂過程的建議. 協和醫學雜志, 2022. DOI: 10.12290/xhyxzz.2022-0528.
20.	范曼如, 申泉, 王丹琦, 等. 臨床實踐指南制訂方法—形成推薦意見的共識方法學. 中國循證心血管醫學雜志, 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. 張薇, 許吉, 鄧宏勇. 國際醫學證據分級與推薦體系發展及現狀. 中國循證醫學雜志, 2019, 19(11): 1373-1378.
2. 陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
3. 王云云, 靳英輝, 陳耀龍, 等. 循證臨床實踐指南推薦意見形成的方法分析. 中國循證醫學雜志, 2017, 17(9): 1085-1092.
4. 趙國楨, 馮碩, 張霄瀟, 等. 中醫藥臨床實踐指南: 現狀和思考. 中國循證醫學雜志, 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. 陳曉煒, 陳錢, 耿勁松, 等. 多準則決策分析應用于醫療保險報銷的系統評價. 中國衛生資源, 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. 多準則決策分析在衛生決策中的應用. 上海: 上海交通大學出版社, 2019.
19. 高一城, 夏如玉, 柴倩云, 等. 組建患者小組: 將患者價值觀與偏好整合融入指南制訂過程的建議. 協和醫學雜志, 2022. DOI: 10.12290/xhyxzz.2022-0528.
20. 范曼如, 申泉, 王丹琦, 等. 臨床實踐指南制訂方法—形成推薦意見的共識方法學. 中國循證心血管醫學雜志, 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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