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.