Background:
Clinical practice guidelines (CPGs) are widely known as a keystone to improving health care. The process of rating the certainty (quality) of evidence has been previously studied. However, little is known about how guideline developers move from evidence to recommendations.

Objectives:
To identify and evaluate systematically how guideline organizations move from evidence to recommendations.

Methods:
We searched for CPGs handbooks in the Guidelines International Network (G-I-N) database, the Cochrane Methodology Register and Google in December 2017. We searched MEDLINE from inception until December 2017. Two reviewers included CPG handbooks, specifically those related to the development process. We excluded handbooks dealing with processes of updating, endorsement or adaptation.

We will characterize the approaches suggested in the handbooks for moving from evidence to decisions, including methodologies for reaching consensus, as well as for deciding the relative importance of the different factors considered. Additionally, we will evaluate the degree of consistency of the approaches identified with respect to the GRADE evidence to decision (EtD) framework.

Preliminary results:
We have identified a total of 67 handbooks for the development of clinical practice guidelines and successfully piloted the data extraction form. One reviewer is extracting the information from the handbooks, and a second reviewer will check the data for accuracy.

Conclusions:
Our findings will support further developments of the guidance for conducting CPGs, especially when it comes to the use of systematic and transparent processes for moving from evidence to recommendations.

Patient or healthcare consumer involvement:
A group of five guideline developers/methodologists and a healthcare provider will support the team in the interpretation, dissemination, and drafting the recommendations.