GRADE guidance 40: The GRADE evidence-to-decision framework for environmental and occupational health

Emily Senerth, Department of Epidemiology, George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW #2, Washington, DC 20052, USA; Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205, USA.
Paul Whaley, Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205, USA; Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK. Electronic address: paul@whaleyresearch.uk.
Elie Akl, American University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
Brandy Beverly, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC 27709, USA.
Pablo Alonso-Coello, Iberoamerican Cochrane Centre, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Hospital de la Santa Creu i Sant Pau, Building 18, 08025 Barcelona, Spain; Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Andrew Rooney, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC 27709, USA.
Holger J. Schünemann, Clinical Epidemiology and Research Center (CERC), Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 - 20090 Pieve Emanuele (Milano), Italy.
Kristina A. Thayer, Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division, Office of Research and Development, US Environmental Protection Agency, Building B (Room 211i), Research Triangle Park, NC 27711, USA.
Katya Tsaioun, Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205, USA.
Rebecca L. Morgan, Cochrane Canada and McMaster GRADE Centres & Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA. Electronic address: morganrl@mcmaster.ca.

Document Type

Journal Article

Publication Date

2-1-2025

Journal

Environment international

Volume

197

DOI

10.1016/j.envint.2025.109314

Keywords

Decision framework; Decision-making; Environmental health; GRADE; Occupational health

Abstract

OBJECTIVE: To provide guidance for the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision (EtD) framework for environmental and occupational health (EOH). STUDY DESIGN AND SETTING: We conducted a systematic review and narrative synthesis of published and public EOH decision frameworks, followed by a modified Delphi process leading to development of a draft GRADE EtD framework for EOH. We pilot tested the provisional framework through a virtual workshop series, which further informed guidance for the framework's application. We presented a summary of the results to all attendees of the GRADE Working Group meeting for feedback in July 2022 and November 2022, and for approval in May 2023. RESULTS: Consistent with existing GRADE EtD frameworks, the EtD framework for EOH includes a scoping and contextualization process and twelve assessment criteria. Modifications to the existing EtD frameworks include: consideration of the socio-political context when making judgments about the priority of the problem and feasibility of different alternatives; the addition of timing when making judgments about benefits and harms, the balance of effects, and feasibility; broadening of the equity criterion to include considerations beyond health equity; and more explicit accommodation of variable or conflicting stakeholder views when considering values and acceptability. The new EtD framework is also accompanied by a user guide intended to support its implementation in the EOH context. CONCLUSION: Policymakers, regulators, and other stakeholders may use this GRADE EtD framework to approach decision-making about environmental and occupational exposures and interventions.

Department

Epidemiology

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