Summarizing an approach for tailoring the GRADE EtD framework for new contexts Commentary on 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; Evidence-Based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205.
• Paul Whaley, Evidence-Based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205; Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK. Electronic address: [email protected].
• 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 USA 27709.
• Pablo Alonso-Coello, Institut de Recerca Sant Pau (IR Sant Pau-CIBERESP), Sant Quintí 77-79, 08041 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 USA 27709.
• Holger J. Schünemann, 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; Clinical Epidemiology and Research Center (CERC), Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 - 20090 Pieve Emanuele (Milano) Italy.
• Katya Tsaioun, Evidence-Based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Rm: W7032, Baltimore, MD 21205.
• Rebecca L. Morgan, 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. Electronic address: [email protected].

Document Type

Journal Article

Publication Date

3-7-2026

Journal

Journal of clinical epidemiology

DOI

10.1016/j.jclinepi.2026.112217

Abstract

This commentary provides contextual information to support interpretation of new 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). Based on a systematic review and narrative synthesis of EOH decision frameworks, and input from subject matter experts in environmental health and GRADE, we developed and pilot-tested an EOH framework through a series of virtual workshops. The resulting guidance was approved by the GRADE Working Group in May 2023. The new EtD framework for EOH follows the same structure as existing EtD frameworks, including a scoping and contextualization process and twelve assessment criteria. Modifications to the framework to improve applicability for the EOH context include changes to terminology, tailoring of the framework detailed judgments (e.g., broadening the scope of the equity decision criterion to include non-health equity issues), and guidance for users (e.g., emphasis on the scoping phase of the guideline development process).

APA Citation

Senerth, Emily; Whaley, Paul; Akl, Elie; Beverly, Brandy; Alonso-Coello, Pablo; Rooney, Andrew; Schünemann, Holger J.; Tsaioun, Katya; and Morgan, Rebecca L., "Summarizing an approach for tailoring the GRADE EtD framework for new contexts Commentary on GRADE Guidance 40: The GRADE evidence-to-decision framework for environmental and occupational health" (2026). GW Authored Works. Paper 8921.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8921

Department

Epidemiology