GRADE Guidance: Update on Developing Good Practice Statements in Guidelines

Despite published guidance by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group on the use of good practice statements (GPSs), their appropriate development remains challenging. This article provides updated guidance with nuanced operationalization. The updated guidance was developed on the basis of examples and iterative discussions. The lead authors refined the approach according to the feedback from GRADE Working Group meetings and presented the summary of the results to all attendees of the GRADE Working Group meeting for feedback in September 2023 and for final approval in September 2024. The 5 signaling questions from the original guidance were leveraged, and the authors recommend that guideline developers select relevant Evidence to Decision criteria to assess the potential downstream consequences of implementing the statement. They have updated the definition of a GPS, classifying GPSs into the following 3 categories: those grounded in ethics and human rights; those grounded in essential principles, practices, and protocols; and those grounded in established scientific evidence. Practical examples accompany the steps as they relate to each type of GPS. In addition, the authors introduce a tool to streamline GPS development and enhance the reporting process. This GRADE guidance article provides an update on when and how to develop a GPS. Adherence to the guidance will add to the trustworthiness of guidelines and may facilitate reducing the inappropriate use or overuse of the GPS.

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Publication Details

Journal
Annals of Internal Medicine
Published
2026-01-19
DOI
https://doi.org/10.7326/annals-25-00431
Citations
1
Primary Topic
Clinical practice guidelines implementation
Type
article
Field-Weighted Citation Impact
41.85
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article

GRADE Guidance: Update on Developing Good Practice Statements in Guidelines

Tamara Lotfi, Benjamin Djulbegović, Peter Tugwell, Elena Stallings et al.
1 citations
Annals of Internal Medicine
Clinical practice guidelines implementation
41.85
article

GRADE Guidance: Update on Developing Good Practice Statements in Guidelines

Tamara Lotfi, Benjamin Djulbegović, Peter Tugwell, Elena Stallings, Joseph L. Mathew, María Ximena Rojas, Miloslav Klugar, C. Canelo-Aybar, Omar Dewidar, Antonio Bognanni, David Rigau, Martin Mayer, Joerg J Meerpohl, Miranda Langendam, Rebecca L. Morgan, Gian Paolo Morgano, Thomas Piggott, Andrea Darzi, Derek Chu, Alfonso Iorio, Kevin Pottie, A. F. Turgeon, Alexander G. Mathioudakis, Zachary Munn, Gordon Guyatt, Pablo Alonso-Coello, Holger J Schünemann, M Hassan Murad, Amir Qaseem, Tatyana A Shamliyan, Melanie Marti, Elena Parmelli, Zuleika Saz-Parkinson, Elie A Akl, Romina Brignardello-Petersen
article en
1 citations

Abstract

Despite published guidance by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group on the use of good practice statements (GPSs), their appropriate development remains challenging. This article provides updated guidance with nuanced operationalization. The updated guidance was developed on the basis of examples and iterative discussions. The lead authors refined the approach according to the feedback from GRADE Working Group meetings and presented the summary of the results to all attendees of the GRADE Working Group meeting for feedback in September 2023 and for final approval in September 2024. The 5 signaling questions from the original guidance were leveraged, and the authors recommend that guideline developers select relevant Evidence to Decision criteria to assess the potential downstream consequences of implementing the statement. They have updated the definition of a GPS, classifying GPSs into the following 3 categories: those grounded in ethics and human rights; those grounded in essential principles, practices, and protocols; and those grounded in established scientific evidence. Practical examples accompany the steps as they relate to each type of GPS. In addition, the authors introduce a tool to streamline GPS development and enhance the reporting process. This GRADE guidance article provides an update on when and how to develop a GPS. Adherence to the guidance will add to the trustworthiness of guidelines and may facilitate reducing the inappropriate use or overuse of the GPS.

Annals of Internal MedicineVol. 179(3)
Dalhousie University (CA), Mayo Clinic (US), Humanitas University (IT), Medical University of South Carolina (US), University of Freiburg (DE), Manchester Academic Health Science Centre (GB), European Commission (BE), University Medical Center Freiburg (DE), Hospital de Sant Pau (ES), American College of Physicians (US), EBSCO Industries (United States) (US), World Health Organization (CH), Instituto Ramón y Cajal de Investigación Sanitaria (ES), Bruyère (CA), Iberoamerican Cochrane Centre (ES), Amsterdam University Medical Centers (NL), Hospital Universitario Ramón y Cajal (ES), Université Laval (CA), Post Graduate Institute of Medical Education and Research (IN), The University of Adelaide (AU), Case Western Reserve University (US), Palacký University Olomouc (CZ), University of Amsterdam (NL), McMaster University (CA), American University of Beirut (LB)
Peace, Justice and strong institutions
Openalex Percentile: Top 1%
Clinical practice guidelines implementation
41.85
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