Summarizing an approach for tailoring the GRADE EtD framework for new contexts Commentary on GRADE Guidance 40: The GRADE evidence-to-decision framework for environmental and occupational health

This commentary provides contextual information to support interpretation of new guidance for the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision (EtD) framework for environmental and occupational health (EOH). Based on a systematic review and narrative synthesis of EOH decision frameworks, and input from subject matter experts in environmental health and GRADE, we developed and pilot-tested an EOH framework through a series of virtual workshops. The resulting guidance was approved by the GRADE Working Group in May 2023. The new EtD framework for EOH follows the same structure as existing EtD frameworks, including a scoping and contextualization process and twelve assessment criteria. Modifications to the framework to improve applicability for the EOH context include changes to terminology, tailoring of the framework detailed judgments (e.g., broadening the scope of the equity decision criterion to include non-health equity issues), and guidance for users (e.g., emphasis on the scoping phase of the guideline development process).