Table 3

Improving the good practice statement evaluation framework

Evaluation questionsExplanation and signalling questionsJudgement
Is collecting and summarising the evidence a poor use of a guideline panel’s limited time and energy (opportunity cost is large)?
  • Would the investigation of the effect of intervention result only in high certinty indirect evidence? that is, cannot directly investigate the effect of the intervention by comparing to the alternative of the intervention as it would not be sensible/ethical) Answer ‘Yes’

  • Does the evaluator believe that the alternative of the intervention is highly unlikely to be chosen due to ethical and human right issues? Answer ‘Probably yes’

Y/PY/PN/N
Is the message really necessary in regard to actual healthcare practice?
  • Do the authors provide a rationale in the text of the guideline to why this message is necessary? Answer ‘Yes’

  • Does the evaluator believe that the statement is relevant to healthcare practice? Answer ‘Probably yes’

Y/PY/PN/N
After consideration of all relevant outcomes and potential downstream consequences, does implementing the good practice statement likely results in a large net positive consequence?
  • Is there any information referenced that the implementation of the good practice statement would have a net positive impact on health outcomes, as well as on relevant Evidence to Decision criteria (eg, equity)? Answer ‘Yes’

  • Does the evaluator believe that the implementation of the good practice statement would have a net positive impact on health outcomes, as well as on relevant Evidence to Decision) criteria? Answer ‘Probably yes’

Y/PY/PN/N
Is there a well-documented clear and explicit rationale connecting the indirect evidence?
  • Is there a description in the guideline text of the chain of linked indirect evidence, used to infer the net desirable consequences (mainly large health benefits) on the implementation of the good practice statement? Answer ‘yes’

  • Does the evaluator believe that there is a chain of linked indirect evidence that can infer the net desirable consequences (mainly large health benefits) on the implementation of the good practice statement? Answer ‘Probably yes’

Y/PY/PN/N
Is the statement clear and actionable?
  • Does the statement specify what actions are needed while specifying population or setting in the standard PIC format? Answer ‘Yes’

  • Does the statement specify what action is needed while specifying population or setting but not in the standard PIC format? Answer ‘Probably yes’

Y/PY/PN/N
  • Outcome is not relevant for the actionable statement as not all outcomes can be addressed in an actionable statement. Outcomes are also not typically part of a recommendation.

  • PIC, Population, Intervention, Comparator.