Evidence to Decision frameworks (EtDs) for policy makers

What is Evidence to Decision framework (EtD)?

The purpose of EtD frameworks is to help groups of people (panels) making healthcare recommendations or decisions move from evidence to decisions. Frameworks can:

  • Inform panel members’ judgements about the pros and cons of each intervention that is considered
  • Ensure the important factors that determine a decision (criteria) are considered
  • Provide a concise summary of the best available research evidence to inform judgements about each criterion
  • Help structure discussion and identify reasons for disagreements
  • Make the basis for decisions transparent to guideline users or those affected by a policy decision

The framework is easily adaptable for use in making clinical recommendations, coverage-decisions, or health system and public health recommendations and decisions.

EtD frameworks include key BACKGROUND information, CRITERIA for making a decision, and CONCLUSION.

The BACKGROUND includes details of the question addressed by the framework and a brief summary of information that the panel (or others) need to know in order to understand the question and why a recommendation or decision is needed.

The CRITERIA include the following:

  • CRITERIA (factors that should be considered) for making the decision

  • JUDGEMENT that the panel members must make in relation to each criterion, which can be draft judgements suggested by the people who have prepared the framework or judgements made by the panel

  • RESEARCH EVIDENCE to inform each of those judgements, which may include links to more detailed summaries of the evidence

  • ADDITIONAL CONSIDERATIONS that inform or justify each judgement


The CONCLUSION that the panel must reach, based on the judgments made for all of the criteria.

(More information about EdT frameworks)

How are EdT frameworks for health systems currently being used?

The frameworks can be used in different ways, including as a tool for a guideline panel to move from evidence to recommendations, and as a way to present to the end users of the guidelines the different factors and associated judgments that influenced the panel’s decision.

Early versions of the framework have been used by two World Health Organisation panels making global recommendations. Feedback from these groups has led to improved versions of the framework.

Example - The DECIDE Evidence to Recommendations Framework in use:

In 2011 the World Health Organisation established a guideline panel to answer the following health systems question: “Which mother and newborn healthcare interventions can safely and effectively be moved to health workers with lower levels of training?” A technical team of researchers broke this down into 128 individual questions and searched for global evidence on relevant issues. Frameworks were filled in for each question. The panel then worked together to arrive at a recommendation for each question, using the frameworks to structure and inform their discussions. (See also Collaboration with the WHO) Text from the last page of each framework served as a summary for publication, with a link to the rest of the underlying framework and the supporting evidence. 

We are currently carrying out rounds of stakeholder feedback and user testing. Later we will be testing the framework in randomised trials.

Templates and instructions for use

You can create a EdT framework at iEtD.

Relevant publications from staff at Cochrane Norway:

Shaun Treweek et al. Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results. Implementation Science 2013, 8:6.


DECIDE is a 5-year project (running from January 2011 to 2015) co-funded by the European Commission under the Seventh Framework Programme.

More information about EdT frameworks.