Development of living evidence-informed guidelines, part 3: Formulation of recommendations

Background: Evidence-informed guidelines provide a basis for optimal clinical and public health decisions. Rigorous methodological standards have been developed for producing guidelines, and the purpose of this article is to consolidate and elaborate on these methods. Types of Studies Reviewed: The body of evidence addressing methodological aspects for developing the first version of a guideline in the context of living evidence-informed clinical and public health guidelines was included. The latest version of methodological handbooks and articles presenting guideline methodology were selected. Results: Guideline panels develop guideline questions and prioritize outcomes for decision making. Evidence syntheses provide summaries of the best available evidence to answer these questions. This evidence includes the benefits and harms of interventions, the certainty in this evidence, and people's values and preferences, among others. The guideline panel assesses this evidence and makes judgments when formulating recommendations. Guideline recommendations are disseminated and repackaged into implementation tools for the target users. Conclusions and Practical Implications: Guideline recommendations developed following the rigorous and transparent methods outlined here equip clinicians and other target users with trustworthy information that can support better decision making and improve patient outcomes.