025 The Efficiency-Validity Methodological Continuum (EVMC) For Sustainable Guideline (CPG) Development: A Negotiating Tool for Credible Compromises in Quality for Affordable Trustworthy Guidelines

Abstract

Background Research methodologists and guideline sponsors are on a collision course as growing demands for scientific rigour raise costs and lengthen delays in CPG production. Objectives To design a tool for CPG developers and sponsors to negotiate methodological compromises while preserving CPG trustworthiness. There are already variations in CPG quality that we tolerate. Flawless systematic reviews and guidelines are unrealistic. Methodological compromises are inevitable and imposed by practical constraints. Negotiating and reporting methodological compromises can fill a transparency gap where methodological choices are made in the development of a CPG. Methods Three individuals with guideline development experience collaborated to design a tool that aligns stakeholders' interests while preserving 'trustworthiness' and enhancing transparency. Results The Efficiency-Validity Methodological Continuum (EVMC) is anchored at the extremes by "practical" at the "efficiency" pole and "best achievable" at the "validity" pole, highlighting the tradeoffs. The continuum between these is represented as a solid line. A 'zone of preference' closer to the 'validity' and a 'zone of acceptability' closer to efficiency are negotiating zones. Beyond the anchors, represented as broken lines, are "expedience" at the efficiency end and "ideal" at the validity end. Guideline development should operate within the solid segment of the continuum. The broken segment towards 'expedient' risks methods with unacceptable threats to validity; and towards ideal, an unaffordable standard not worth the incremental costs. Examples highlight the tool's utility. Conclusions Negotiating and reporting compromises in methodological quality can lead to sensible, transparent methodological choices acceptable to both CPG developers and sponsors.