Development of a framework to structure decision-making in environmental and occupational health: A systematic review and Delphi study
Por:
Senerth, E, Whaley, P, Akl, E, Beverly, B, Alonso-Coello, P, Jalil, E, Khattar, J, Palmer, NR, Rooney, A, Schuenemann, HJ, Thayer, KA, Tsaioun, K, Morgan, RL
Publicada:
1 ene 2025
Ahead of Print:
1 ene 2025
Resumen:
Background: Environmental and occupational health (EOH) assessments increasingly utilize systematic review methods and structured frameworks for evaluating evidence about the human health effects of exposures. However, there is no prevailing approach for how to integrate this evidence into decisions or recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence-to-decision (EtD) frameworks provide a structure to support standardized and transparent consideration of relevant criteria to inform health decisions. This study identifies and synthesizes available EOH decision frameworks and evaluates the applicability and usability of an existing GRADE EtD perspective to advance the development of a tailored EOH EtD framework. Methods: We performed a systematic review of MEDLINE, EMBASE, and Cochrane Library, and a manual search of gray literature to identify frameworks that inform decision-making about EOH exposures from the years 2011 to 2021. We abstracted and analyzed decision considerations from each framework through narrative synthesis. Next, we conducted a two-round Delphi process, engaging stakeholders from the following perspectives within environmental and occupational health: risk assessment and management, nutrition and food safety, cancer, and socio-economic analysis. Panelists rated the relevance and wording of each consideration on a 7-point Likert scale and provided free-text comments during both phases. Considerations that did not meet predetermined thresholds were excluded. Results: Out of 5,196 unique references, we identified 22 published reports of EOH decision frameworks. We identified another 16 frameworks in a search of gray literature, totaling 38 source frameworks. We abstracted 560 individual decision considerations from these frameworks, 104 of which may contribute additional information to the guidance, scope, context, or assessment criteria of the GRADE EtD framework. In round 1 of the Delphi study, 50 decision considerations were aggregated or removed, and 9 were aggregated or removed after round 2, for a final total of 47. No new decision considerations were added in either round. We identified several differences between decision criteria that are applied in EOH and the GRADE EtD framework, including vocabulary that is specific to EOH (e.g., toxicity, the precautionary principle), and granularity of the EOH decision considerations (e.g., detailed signaling questions to assess feasibility and resources required). However, this study did not identify any EOH decision criteria that are completely distinct from the GRADE EtD framework. Conclusions: Findings of this mixed-methods study comprise a foundation for a GRADE EtD that is applicable for use in EOH decision-making, with implications for approaches to regulation of environmental and occupational exposures and the formulation of recommendations for interventions to prevent or mitigate undesirable health and other consequences.
Filiaciones:
Senerth, E:
George Washington Univ, Milken Inst Sch Publ Hlth, Dept Epidemiol, 950 New Hampshire Ave NW 2, Washington, DC 20052 USA
Whaley, P:
Johns Hopkins Bloomberg Sch Publ Hlth, Evidence Based Toxicol Collaborat, 615 North Wolfe St,Rm W7032, Baltimore, MD 21205 USA
Univ Lancaster, Lancaster Environm Ctr, Lancaster LA1 4YQ, England
Akl, E:
Amer Univ Beirut, POB 11-0236, Beirut, Lebanon
Beverly, B:
NIEHS, Div Natl Toxicol Program, NIH, Dept Hlth & Human Serv, POB 12233,Mail Drop K2-02, Res Triangle Pk, NC 27709 USA
Alonso-Coello, P:
Inst Recerca Sant Pau IR Sant Pau CIBERESP, Sant Quinti 77-79, Barcelona 08041, Spain
Ctr Cochrane Iberoamer, Sant Antoni Maria Claret 167, Barcelona 08025, Spain
Drone Hopper Co, Madrid, Spain
Jalil, E:
McMaster Univ, Hlth Sci Ctr, Dept Hlth Res Methods Evidence & Impact, Room 2C14,1280 Main St West, Hamilton, ON L8S 4K1, Canada
Khattar, J:
McMaster Univ, Hlth Sci Ctr, Dept Hlth Res Methods Evidence & Impact, Room 2C14,1280 Main St West, Hamilton, ON L8S 4K1, Canada
Palmer, NR:
McMaster Univ, Hlth Sci Ctr, Dept Hlth Res Methods Evidence & Impact, Room 2C14,1280 Main St West, Hamilton, ON L8S 4K1, Canada
Rooney, A:
NIEHS, Div Natl Toxicol Program, NIH, Dept Hlth & Human Serv, POB 12233,Mail Drop K2-02, Res Triangle Pk, NC 27709 USA
Schuenemann, HJ:
Ctr Cochrane Iberoamer, Sant Antoni Maria Claret 167, Barcelona 08025, Spain
Thayer, KA:
US Environm Protect Agcy, Ctr Publ Hlth & Environm Assessment, Chem & Pollutant Assessment Div, Off Res & Dev, Bldg B,Room 211i, Res Triangle Pk, NC 27711 USA
Tsaioun, K:
Johns Hopkins Bloomberg Sch Publ Hlth, Evidence Based Toxicol Collaborat, 615 North Wolfe St,Rm W7032, Baltimore, MD 21205 USA
Morgan, RL:
McMaster Univ, Hlth Sci Ctr, Dept Hlth Res Methods Evidence & Impact, Room 2C14,1280 Main St West, Hamilton, ON L8S 4K1, Canada
Case Western Reserve Univ Sch Med, 10900 Euclid Ave, Cleveland Hts, OH 44106 USA
Green Submitted, gold
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