Methods including conflict-of-interest management were established a priori and are described in the online supplement. The document can be conceptualized in two parts. Narrative portions (e.g., radiological criteria, histopathological criteria, physiological criteria, definitions) were created using consensus by discussion. Guideline portions address specific questions related to TBLC, genomic classifier testing, antacid medication, antireflux surgery for IPF, and pirfenidone and nintedanib for PPF. These sections are compliant with the Institute of Medicine standards for trustworthy guidelines (6 ) and yield recommendations that were informed by systematic reviews and were formulated and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (7 (link)) (Table 1).
Evidence-based recommendations were formulated by discussion followed by voting. Briefly, committee members were provided the following options: a strong recommendation for a course of action, a conditional recommendation for a course of action, a conditional recommendation against a course of action, a strong recommendation against a course of action, and abstention (Table 2). Abstention was appropriate whenever a committee member was unwilling to commit for or against the proposed course of action, such as when there was insufficient evidence, or the committee member had insufficient expertise or a self-realized bias. Three outcomes were possible: