title: Estimating benefits and harms of screening across subgroups: the Canadian Task Force on Preventive Health Care integrates the GRADE approach and overcomes minor challenges.
abstract: OBJECTIVE
  This paper describes the integration of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach into their clinical preventive guideline development process by the new Canadian Task Force on Preventive Health Care.
  
  
  METHODS
  The GRADE approach focused the analytic framework and key questions on patient-important benefits and harms related to screening that incorporated detection, treatment, and follow-up. It also led to an explicit consideration of values and preferences and resource implications on the basis of the recommendations.
  
  
  RESULTS
  There are challenges, however, in incorporating the GRADE approach to clinical prevention, as the randomized controlled trials in this field have needed to be very large and of long duration, given the rare occurrence of primary outcome events in asymptomatic individuals. We provide examples of how we met these challenges in relation to developing clinical guidelines for screening for breast cancer, cervical cancer, diabetes, hypertension, and depression in primary care settings.
  
  
  CONCLUSIONS
  The focus on the patient-important outcomes was helpful in estimating effectiveness of screening approaches and providing explicit detailing of the basis of our recommendations across subgroups.
authors.affiliation: Departments of Family Medicine and Epidemiology and Community Medicine, CT Lamont Primary Health Care Research Centre, University of Ottawa, Ottawa, Canada. kpottie@uottawa.ca
authors.forename: Kevin
authors.initials: K
authors.lastname: Pottie
authors.forename: Sarah
authors.initials: S
authors.lastname: Connor Gorber
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.forename: Michel
authors.initials: M
authors.lastname: Joffres
authors.forename: Patrice
authors.initials: P
authors.lastname: Lindsay
authors.forename: Paula
authors.initials: P
authors.lastname: Brauer
authors.forename: Alejandra
authors.initials: A
authors.lastname: Jaramillo
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
mesh_terms: D026683:Advisory Committees; D002170:Canada; D019317:Evidence-Based Medicine; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000458:organization & administration*; D016032:Randomized Controlled Trials as Topic