TABLE OF CONTENTS

1. Overview
GRADEpro also facilitates the initial stages of guideline development. Using the Outcomes generation module, you can compose a list of the relevant outcomes to measure the effects of the intervention in collaboration with your Panel Members.
2. The process
The process consists of a few stages, including brainstorming when the outcomes are proposed and rating when the most relevant outcomes are selected. In the end, the selected outcomes are automatically transferred into the Comparisons section.

2.1 Before you begin
To go through with the Outcomes generation process, you need to have at least one PICO question entered in the Comparisons section of your project.

This is because outcomes in GRADEpro need to be added to evidence tables in existing questions.
You can add questions in the Comparisons section either manually or through the Questions generation process.
2.2 Brainstorming
In the first step, you can add some outcomes before opening the list to the panel's suggestions. You can do this with the Add outcome button.

You will then see a text field where you can enter the outcome name as well as the list of all the questions in your project. You can mark any or all of the questions to suggest the new item as a potential outcome for those questions. If questions are organised in groups, only the group name is shown on the list, and if it's ticked, the outcome is suggested for all the questions in this group.

After you add the outcome, you can edit it, duplicate it or delete it. 
You can also drag and drop outcomes between questions.

Once you have added all the desired outcomes, you can open the list for Panel Members' input. To do this, please use the send button. Sending the form to the panel is irreversible.

Remember: Please be aware that all the people marked as Panel Members within the Team section of your project will receive the list of questions with suggested outcomes.Then all of the Panel Members will be able to provide their comments and suggested outcomes.
Remember: Please be aware that the Panel Members will not see one another’s suggestions, only the initial list they were sent. You can check what the process looks like from panelist perspective in a separate article.As the Panel Members submit their forms, you will see suggested outcomes and comments appear on your list, labelled in orange. The number of responses will rise as well.

You may have to use the Refresh button to see the answers.
You can also preview the comments provided by the Panel Members either by clicking on the comment icon on the right-hand side or by using the Show all comments option.
Remember: Please be aware that all the comments will be anonymous. You will not be able also to check which members of the panel have provided feedback. Panel Members will be able to send their responses until you close the form and proceed to the next stage.
Remember: Closing the form is irreversible. Once you close it and move to the next stage, the Panel Members won't be able to add any more suggestions.2.3 Moderation (Completed brainstorming)
In the next step, you will be able to edit the outcomes, both the ones entered by you and submitted by the Panel Members. You will also be able to enter new outcomes if need be or delete the redundant ones.

Once you are satisfied with the outcomes list, you can submit it for rating by the Panel Members. Sending the form is irreversible.
2.4 Prioritisation
In this part, the Panel Members will decide on the priority of each outcome. You will see the list of all Panel Members.
Once any person submits their form, the label next to their name will turn green.

You will not, however, be able to see the exact answers of each person until you close the Prioritisation stage.
Remember: Closing the form is irreversible. Once you close it and move to the next stage, the Panel Members won't be able to provide any more ratings.2.5 Final list
In the next step, you will see the list of outcomes and their median priority results on a scale from 1 to 9.

You can preview the individual ratings; however, they will remain anonymous (they will be marked as TM - Team Member - and a number).

Based on the panel's answers, GRADEpro will suggest further actions regarding each outcome.
- Outcomes with a median rating of 3 or lower are suggested for exclusion.
- Outcomes with a median rating higher than 3 but lower than 6 are suggested for inclusion with the rating of important.
- Outcomes with a median rating higher than 6 are suggested for inclusion with the rating of critical.
The suggestions made by GRADEpro can be manually overwritten.
As you make those decisions, the outcomes will change the highlight colour.
The last step will be to send the list for final approval by the Panel Members.
2.6 Approval
In the next stage, you will see the list of the outcomes grouped according to the decisions you made in the previous step.

Once the Panel Members provide their feedback, you will see the percentage of the approve and disapprove answers among the respondents. The Panel Members are required to provide comments if they disagree, and you will be able to preview these comments.

In the comments preview, you will be able to see the following:
- The initially suggested priority of the outcome
- The percentage and exact number of people who disagreed with the initial suggestion
- Anonymous comments of people who disagree

To facilitate the discussion process regarding the disagreement, you can:
- Add and save your own comments (they will be only seen by you and other project admins)
- Add tasks and later on mark them as done
In the end, you can mark the disagreement as resolved, and it will no longer be highlighted in red.

If the discussion results in changing the final priority of the outcome, you can easily move the outcome to another group by clicking on it and dragging it with your cursor.
2.7 Export
In the end, you can close the approval stage, and the outcomes will be transferred to the questions in the Comparisons section, where you can enter the data for the outcomes and then assess the certainty of evidence.
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