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

Authors

• 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

3-1-2025

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.

APA Citation

Senerth, Emily; Whaley, Paul; Akl, Elie; Beverly, Brandy; Alonso-Coello, Pablo; Rooney, Andrew; Schünemann, Holger J.; Thayer, Kristina A.; Tsaioun, Katya; and Morgan, Rebecca L., "GRADE guidance 40: The GRADE evidence-to-decision framework for environmental and occupational health" (2025). GW Authored Works. Paper 6895.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6895

Department

Epidemiology