Abstract：
OBJECTIVE: To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics.
METHODS: Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience.
RESULTS: The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four \'conditional\' recommendations.
CONCLUSIONS: The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
METHODS: Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience.
RESULTS: The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four \'conditional\' recommendations.
CONCLUSIONS: The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
摘要：
目的：描述在制定阿片类镇痛药处方的循证临床实践指南建议时，决策证据（EtD）框架的开发和使用。
方法：证据来自对医疗保健专业人员和服用阿片类药物治疗疼痛的人进行的系统评价和定性研究的概述。一个多学科指南制定小组进行了广泛的EtD框架审查和迭代完善，以确保指南建议能够捕获与指南目标设置和受众相关的环境因素。
结果：指南制定小组考虑并解释了个体和卫生系统层面阿片类药物处方的复杂性，塑造建议和实践要点，以促进即时护理使用。利益相关者表现出不同的偏好，信仰,和价值观。这种可变性，证据确定性低，系统层面的政策和筹资模式影响了所产生建议的强度，导致制定了四个“有条件的”建议。
结论：考虑基于证据的建议的背景，以及政治和卫生系统环境，可以为建议实施的成功做出贡献。使用EtD框架可以通过考虑证据的局限性和相关的环境因素来制定与护理点相关的可实施建议。
方法：证据来自对医疗保健专业人员和服用阿片类药物治疗疼痛的人进行的系统评价和定性研究的概述。一个多学科指南制定小组进行了广泛的EtD框架审查和迭代完善，以确保指南建议能够捕获与指南目标设置和受众相关的环境因素。
结果：指南制定小组考虑并解释了个体和卫生系统层面阿片类药物处方的复杂性，塑造建议和实践要点，以促进即时护理使用。利益相关者表现出不同的偏好，信仰,和价值观。这种可变性，证据确定性低，系统层面的政策和筹资模式影响了所产生建议的强度，导致制定了四个“有条件的”建议。
结论：考虑基于证据的建议的背景，以及政治和卫生系统环境，可以为建议实施的成功做出贡献。使用EtD框架可以通过考虑证据的局限性和相关的环境因素来制定与护理点相关的可实施建议。
