Evidence-to-decision frameworks: a review and analysis to inform decision-making for environmental health interventions

Abstract

AbstractBackgroundEvidence-to-decision (EtD) frameworks provide a structured and transparent approach for groups of experts to use when formulating recommendations or making decisions. While extensively used for clinical and public health recommendations, EtD frameworks are not in widespread use in environmental health.ObjectivesThis review sought to identify, compare and contrast key EtD frameworks for decisions or recommendations on interventions used in clinical medicine, public health or environmental health. Our goal was to identify best practices and guidance which will be used to inform the development of an EtD framework for formulating recommendations regarding interventions to prevent or mitigate the harmful effects of exposure to substances in the environment.MethodsWe identified a convenience sample of EtD frameworks used by a range of organizations. We searched Medline for systematic reviews of EtD frameworks used in clinical medicine, and public or environmental health. In a qualitative manner, we summarized the decision criteria in the selected frameworks and in the reviews.ResultsFourteen key organizations provided 18 EtD frameworks; most frameworks focused on clinical medicine or public health interventions; four focused on environmental health and three on economic considerations. Only one framework was based on an underlying conceptual model, and rarely was a systematic review of potential criteria performed during the frameworks development. GRADE encompasses a set of closely related frameworks for different types of decisions. Harms of interventions were examined in all frameworks and benefits in all but one. Other criteria included certainty of the body of evidence (15 frameworks), resource considerations (15), feasibility (13), equity (12), values (11), acceptability (11), and human rights (2). There was variation in how specific criteria were defined. The five identified systematic reviews reported a similar spectrum of EtD criteria.DiscussionThe EtD frameworks examined encompassed similar criteria, with tailoring to specific audience needs. However, there is variation in development processes, terminology, level of detail provided and presentation of the criteria. Existing frameworks are a useful starting point for development of one tailored to decision-making in environmental health.