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Evidence-Based Decision Making in Urology: Assessing the Quality of Evidence Using GRADE
18PG
Sunday, May 30, 2010, 8:30 - 11:45 a.m.
Philipp Dahm, MD, MHSc, FACS, Course Director
Associate Professor of Urology
Director of Clinical Research
Associate Residency Program Director
University of Florida
Gainesville, FL
Steven E. Canfield, MD
Assistant Professor of Urology
Associate Program Director
University of Texas Medical School
Houston, TX
Tracey L. Krupski, MD, MPH
Assistant Professor of Urology
University of Virginia
Charlottesville, VA
This course is aimed at a broad spectrum of urologists and affiliated healthcare providers who are involved in individual patient care, education, clinical pathway development and policy making, as well as those involved in guideline development. We will introduce urology-relevant resources to search and retrieve the latest clinical research studies and provide the tools to systematically evaluate these studies for the quality of evidence and formulate clinical recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. In practical exercises, we will first demonstrate how to formulate a focused clinical question that relates to patient relevant outcomes. We will then introduce a framework on how to assess the methodological strengths and weaknesses of randomized controlled trials and observational studies. Aside from study design, we will review other critical factors in determining the quality of evidence using the GRADE system. These include factors that decrease the confidence we have in the results (inconsistency, indirectness, imprecision and the potential for publication bias), as well as factors that may raise the quality of evidence (magnitude of the effect, confounding that would reduce a demonstrated effect and dose-response gradient). We will illustrate how these factors can be summarized in transparent and succinct evidence summaries generated by RevMan and GRADEpro software. Finally, we will discuss how research evidence can be translated into treatment recommendations by considering the balance between desirable and undesirable consequences, the quality of evidence and the variability in patients' values and preferences, and resource use.
Objectives: After attending this course, participants should be able to:
- identify urological literature for published studies that provide the highest quality evidence
- evaluate the quality of evidence provided by randomized controlled trials and observational studies using the GRADE framework
- cite clinical recommendations by considering the balance of desirable and undesirable consequences, the quality of evidence and the variability in patients' values and preferences