title: Decision-Making about Healthcare Related Tests and Diagnostic Strategies: User Testing of GRADE Evidence Tables.
abstract: OBJECTIVE
  To develop guidance on what information to include and how to present it in tables summarizing the evidence from systematic reviews of test accuracy following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
  
  
  METHODS
  To design and refine the evidence tables, we used an iterative process based on the analysis of data from four rounds of discussions, feedback and user testing. During the final round, we conducted one-on-one user testing with target end users. We presented a number of alternative formats of evidence tables to participants and obtained information about users' understanding and preferences.
  
  
  RESULTS
  More than 150 users participated in initial discussions and provided their formal and informal feedback. 20 users completed one-on-one user testing interviews. Almost all participants preferred summarizing the results of systematic reviews of test accuracy in tabular format rather than plain text. Users generally preferred less complex tables but found presenting sensitivity and specificity estimates only as too simplistic. Users found the presentation of test accuracy for several values of prevalence initially confusing but modifying table layout and adding sample clinical scenarios for each prevalence reduced this confusion. Providing information about clinical consequences of testing result was viewed as not feasible for authors of systematic reviews.
  
  
  CONCLUSIONS
  We present the current formats for tables presenting test accuracy following the GRADE approach. These tables can be developed using GRADEpro guidelines development tool (www.guidelinedevelopment.org or www.gradepro.org) and are being further developed into electronic interactive tables that will suit the needs of different end users. The formatting of these tables, and how they influence result interpretation and decision-making will be further evaluated in a randomized trial.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Departments of Internal Medicine and Biomedical & Health Informatics, University of Missouri-Kansas City, Kansas City, United States of America.
authors.forename: Reem A
authors.initials: RA
authors.lastname: Mustafa
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Wojtek
authors.initials: W
authors.lastname: Wiercioch
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Santesso
authors.affiliation: Faculty of Medicine, University of British Colombia, Vancouver, British Columbia, Canada.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Cheung
authors.affiliation: Center for Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Prediger
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Tejan
authors.initials: T
authors.lastname: Baldeh
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago de Chile, Chile.
authors.forename: Alonso
authors.initials: A
authors.lastname: Carrasco-Labra
authors.affiliation: Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago de Chile, Chile; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Romina
authors.initials: R
authors.lastname: Brignardello-Petersen
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Neumann
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bossuyt
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Medizinischer Dienst des Spitzenverbandes Bund der Kranken-kassen e.V. (MDS) Theodor Althoff-Str. 47 45133 Essen, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Lelgemann
authors.affiliation: Abteilung Medizin. GKV-Reinhardtstraße 28 10117 Berlin, Germany.
authors.forename: Diedrich
authors.initials: D
authors.lastname: Bühler
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jan
authors.initials: J
authors.lastname: Brozek
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D013223:Statistics as Topic