Navigating uncertainty in evidence-informed decision-making for traditional, complementary and integrative medicine: An updated critical interpretive review

Background: Evidence-informed decision-making (EIDM) presents unique challenges for traditional, complementary and integrative medicine (TCIM). To aid decision-making, a critical interpretive review was updated to examine how internationally and nationally endorsed consensus statements on guideline development and policy briefs, along with TCIM-specific recommendations may address these challenges. Methods: The review drew on critical interpretive synthesis and rapid review methods. PubMed, CINAHL and AIMED were searched on 19 January 2024. Single reviewers conducted the screening and extracted descriptive data. Analysis began deductively from the original review themes and developed iteratively. Results: Included were 167 publications. Over the past decade, evidence-to-decision (EtD) frameworks have considered a broader range of modifying factors (e.g., importance of the problem, stakeholder preferences, feasibility, costs, health equity, human rights, social impacts) that may warrant making a stronger recommendation despite lower certainty evidence, and vice versa. Additional strategies proposed by TCIM guideline developers included systematically incorporating multiple evidence sources and developing TCIM extensions for reporting guidelines. Four interrelated themes affirmed the importance of 1) transparent and inclusive decision-making, 2) ensuring the scope and framing of the problem are sensitive to TCIM contexts, 3) using diverse types of evidence in EtD frameworks and when there is evidence uncertainty, and 4) centering equity, including epistemic equity, throughout the EIDM process. Conclusion: Advancing EIDM methodologies specifically for TCIM guideline development and policy can help decision-makers navigate evidence uncertainty to support the appropriate integration of TCIM into global health systems. Protocol registration: International Platform of Registered Systematic Review and Meta-analysis Protocols: INPLASY202510066.