25.4.18

Challenges in Developing U.S. Preventive Services Task Force Child Health Recommendations.

Kemper AR, Krist AH, Tseng CW, Gillman MW, Mabry-Hernandez IR, Silverstein M, Chou R,
Lozano P, Calonge BN, Wolff TA, Grossman DC.

Am J Prev Med. 2018 Jan;54(1S1):S63-S69. doi: 10.1016/j.amepre.2017.08.023.

The U.S. Preventive Services Task Force (USPSTF) uses an objective evidence-based
approach to develop recommendations. As part of this process, the USPSTF also
identifies important research gaps in scientific evidence. In March 2016, the
USPSTF convened an expert panel to discuss its portfolio of child and adolescent 
recommendations and identify unique methodologic issues when evaluating evidence 
regarding children and adolescents. The panel identified key domains of
challenges, including measuring patient-centered health outcomes; identifying
intermediate outcomes predictive of important health outcomes; evaluating the
long time horizon needed to assess the balance of benefits and harms;
understanding trajectories of growth and development that result in unique
windows of time when expected benefits or harms of a preventive service can vary;
and considering the perspectives of other individuals who might be affected by
the delivery of a preventive service to a child or adolescent. Although the
expert panel expressed an interest in being able to make more recommendations for
or against preventive services for children and adolescents, it also reinforced
the importance of ensuring recommendations were based on sound and sufficient
evidence to ensure greatest benefit and minimize unnecessary harms. Accordingly, 
the need to highlight areas with insufficient evidence is as important as making 
recommendations. Having identified these key challenges, the USPSTF and other
organizations issuing guidelines have an opportunity to advance their methods of 
evidence synthesis and identified evidence gaps represent important opportunities
for researchers and policy makers.