title: Methodology for Developing Deprescribing Guidelines: Using Evidence and GRADE to Guide Recommendations for Deprescribing.
abstract: BACKGROUND
  Class specific deprescribing guidelines could help clinicians taper and stop medications no longer needed or which may be causing more harm than benefit. We set out to develop methodology to create such guidelines using evidence-based methods for guideline development, evidence synthesis and recommendation rating.
  
  
  RESULTS
  Using a comprehensive checklist for a successful guideline enterprise, we conducted a national modified Delphi consensus process to identify priorities for deprescribing guidelines, then conducted scoping exercises to identify feasible topics, and sequentially developed three deprescribing guidelines. We selected guideline development team members for clinical expertise; a GRADE member worked with staff to ensure guideline development processes were followed. We conducted or used systematic searches and reviews of deprescribing trials of selected drug classes, reviews or systematic reviews of drug class effectiveness, reviews of reviews of drug class harm and narrative syntheses of contextual questions to inform recommendations and guideline development. Our 8 step process for guideline development included defining scope and purpose, developing a logic model to guide the process and generate key clinical questions, setting criteria for admissible evidence and conducting systematic reviews, synthesizing evidence considering additional contextual information and performing quality estimates, formulating recommendations and providing strength estimations, adding clinical considerations, conducting clinical and stakeholder review and finally updating content pre-publication. Innovative aspects of the guideline development process included synthesizing evidence for outcomes of tapering or stopping medication, and incorporating evidence for medication harm into the recommendation strength rating. Through the development of three deprescribing guidelines (for proton pump inhibitors, benzodiazepine receptor agonists and antipsychotics) and associated decision-support algorithms, we were able to gradually hone the methodology; each guideline will be published separately.
  
  
  CONCLUSIONS
  Our methodology demonstrates the importance of searching for short and long-term outcomes, showing the benefits of deprescribing and studying patient preferences. This publication will support development of future deprescribing guidelines.
authors: Bruyère Research Institute, Ottawa, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Canada.|School of Pharmacy, University of Waterloo, Waterloo, Canada.
authors: Barbara
authors: B
authors: Farrell
authors: Bruyère Research Institute, Ottawa, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
authors: Kevin
authors: K
authors: Pottie
authors: School of Pharmacy, University of Waterloo, Waterloo, Canada.|Schlegel-UW Research Institute on Ageing, Waterloo, Canada.
authors: Carlos H
authors: CH
authors: Rojas-Fernandez
authors: Bruyère Research Institute, Ottawa, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
authors: Lise M
authors: LM
authors: Bjerre
authors: Bruyère Research Institute, Ottawa, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
authors: Wade
authors: W
authors: Thompson
authors: Bruyère Research Institute, Ottawa, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
authors: Vivian
authors: V
authors: Welch
mesh_terms: D000069340:Deprescriptions; D011307:Drug Prescriptions / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006301:Health Services Needs and Demand; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*