The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group recently published updated guidance for developing Good Practice Statements (GPSs). Despite prior publications, the correct development and application of these statements remain challenging for guideline developers. Therefore, this new article offers a nuanced operational approach to enhance trustworthiness and reduce the inappropriate use of GPSs.
Key Updates to Good Practice Statements Development
Initially, the guidance leverages the five core signaling questions from the original approach. Furthermore, guideline developers must now select relevant Evidence to Decision (EtD) criteria to properly assess potential downstream consequences. This step helps in understanding the impact of implementing the statement. Importantly, the fundamental definition of a GPS has been revised and clarified. Consequently, the updated guidance classifies GPSs into three distinct categories, providing a clear structure for their application.
The Three Categories of Good Practice Statements
The updated GRADE guidance classifies GPSs into three groups. First, some statements are firmly grounded in ethics and human rights. Second, others stem from essential principles, established practices, and widely accepted protocols. Finally, the third group includes GPSs grounded in established scientific evidence, where the evidence base is clear and uncontroversial. As a result, practical examples accompany the developmental steps for each category of GPS. These examples offer practical clarity on when and how to appropriately use a statement in clinical guidelines. Therefore, this structured approach is crucial for improving guideline quality and adherence.
Streamlining GPS Development and Reporting
In addition to the refined classification, the authors introduced a dedicated tool. This tool aims to streamline the development of Good Practice Statements. Moreover, it enhances the reporting process for these specific recommendations. Adherence to this updated guidance is expected to add significantly to the trustworthiness of clinical guidelines overall. Consequently, medical professionals can rely on these guidelines more confidently. The updated guidance was developed through iterative discussions and was finally approved in September 2024, reflecting broad consensus within the GRADE Working Group. Consequently, incorporating these updated methods will minimize the risk of inappropriate overuse of GPSs.
Frequently Asked Questions
Q1: What are the three new categories for Good Practice Statements?
The updated GRADE guidance classifies GPSs into three categories: those grounded in ethics and human rights; those grounded in essential principles, practices, and protocols; and those grounded in established scientific evidence.
Q2: How does the new GRADE guidance help guideline developers?
The guidance offers a nuanced operational framework, recommends using Evidence to Decision (EtD) criteria to assess consequences, provides a 3-category classification system, and introduces a tool to streamline development and enhance reporting.
Q3: What is the main benefit of following the updated GPS guidance?
Adherence to the guidance is expected to increase the trustworthiness of clinical guidelines and help reduce the inappropriate use or overuse of Good Practice Statements by establishing clear criteria for their development.
References
- Dewidar O et al. GRADE Guidance: Update on Developing Good Practice Statements in Guidelines. Ann Intern Med. 2026 Jan 20. doi: 10.7326/ANNALS-25-00431. PMID: 41554128.
- Guyatt GH, et al. Good practice statements: a practical approach to using evidence to guide decisions. J Clin Epidemiol. 2013 Dec;66(12):1413-7. doi: 10.1016/j.jclinepi.2013.06.002.
- Loke YK, et al. Using GRADE for guideline development in clinical practice. Int J Clin Pract. 2020 Jan;74(1):e13426. doi: 10.1111/ijcp.13426.
- Schünemann HJ, et al. GRADE Evidence to Decision frameworks for health system and public health decisions. J Clin Epidemiol. 2017 Sep;90:45-53. doi: 10.1016/j.jclinepi.2017.06.004.