Formulating recommendations
The TF members graded the strength and consistency of the key findings
from the SRs.7,8 These were used to formulate
evidence-based recommendations for clinical care based on the relative
balance between potential benefits, side effects and
risks.11 (Box 2). This involved formulating clear
recommendations with the strength of evidence underpinning each
recommendation while phrasing was according to the grade of
recommendation (Box 2). For many recommendations in the generic section,
there was only level V evidence available (Grade D), therefore, ‘may be
considered’ is used. To ensure that these recommendations were robust, a
modified Delphi approach was used to achieve consensus within the TF
(see online supplement).
The TF aimed to minimize bias at every step. TF members identified the
resource implications of implementing the recommendations, barriers,
facilitators, potential approaches to the implementation of each
recommendation and suggested audit criteria to help with assessing
organizational compliance.