Table 1:

Interpretation of strength of recommendations using the GRADE approach (12), (13)

CriteriaInterpretation by patientsInterpretation by health care providersInterpretation by policy-makers
Strong recommendation for or against
Desirable consequences CLEARLY OUTWEIGH the undesirable consequences in most settings (or vice versa)Most individuals in this situation would want the recommended course of action, and only a small proportion would not.Most individuals should receive the recommended course of action.
Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator.
Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.		Recommendation can be adopted as policy in most situations.
Conditional recommendation for or against
Desirable consequences PROBABLY OUTWEIGH undesirable consequences in most settings (or vice versa)Most individuals in this situation would want the suggested course of action, but many would not.Clinicians should recognize that different choices will be appropriate for each person and that clinicians must help each person arrive at a management decision consistent with the person’s values and preferences.
Decision aids may be useful to help people make decisions consistent with their values and preferences.		Policy-making will require substantial debate and involvement of various stakeholders.
Good practice statement

  • A good practice statement is an actionable statement necessary for health care practice but is supported by indirect evidence that does not diminish the certainty of evidence.

  • Implementation of the statement should result in large net-positive consequences.

  • Further collection and summary of the evidence would be poor use of guideline panel resources.

  • Note: GRADE = Grading of Recommendations Assessment, Development and Evaluation.