Evidence to Decision (EtD) framework

The purpose of EtD frameworks is to help groups of people (panels) making healthcare recommendations or decisions move from evidence to decisions. Frameworks can:
  • Inform panel members’ judgements about the pros and cons of each intervention that is considered
  • Ensure the important factors that determine a decision (criteria) are considered
  • Provide a concise summary of the best available research evidence to inform judgements about each criterion
  • Help structure discussion and identify reasons for disagreements
  • Make the basis for decisions transparent to guideline users or those affected by a policy decision
The framework is easily adaptable for use in making clinical recommendations, coverage-decisions, or health system and public health recommendations and decisions.
EtD frameworks include key background information, criteria for making a decision, and conclusions.
The background includes details of the question addressed by the framework and a brief summary of information that the panel (or others) need to know in order to understand the question and why a recommendation or decision is needed.
The criteria include the following:
  • Criteria (factors that should be considered) for making the decision
  • Judgements that the panel members must make in relation to each criterion, which can be draft judgements suggested by the people who have prepared the framework or judgements made by the panel
  • Research evidence to inform each of those judgements, which may include links to more detailed summaries of the evidence
  • Additional considerations that inform or justify each judgement
The conclusions that the panel must reach, based on the judgments made for all of the criteria.
Supporting materials:
Guidance on the EtD
  • Full guidance on the EtD is available in GRADEpro 
Flyer on the EtD
Examples of completed EtD frameworks
Tools to support the use of EtDs
  • The EtD is supported in GRADE's official software GRADEProGDT.
  • GRADE Evidence to Decision (EtD) frameworks: A systematic and transparent approach to making well-informed healthcare choices: 1. Introduction. BMJ 2016;353:i2016.
  • GRADE Evidence to Decision (EtD) frameworks: 2. Clinical practice guidelines. BMJ 2016;353:i2089.
  • GRADE Guidelines: 16. GRADE evidence to decision frameworks for tests in clinical practice and public health. JCE 2016; 76: 89-98
  • The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels. Implement Sci. 2016 Jul 15;11:93 
  • GRADE Evidence to Decision Frameworks for adoption, adaptation and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. JCE 2016 (in press)