Table 1.
Definitions of certainty in the evidence and strength of recommendations and implications for patients, clinicians, and policy makers.*
| CATEGORY | DEFINITION |
|---|---|
| Definitions of Certainty (Quality) of the Evidence | |
| High | Very confident that the true effect lies close to that of the estimate of the effect |
| Moderate | Moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different |
| Low | Confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect |
| Very low | Very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. |
| Definitions of Strong and Conditional Recommendations and Implications for Users | |
| Implications for patients | |
| Strong recommendations | Most patients in this situation would want the recommended course of action, and only a small proportion would not. Formal decision aids are not likely to be needed to help patients make decisions consistent with their values and preferences |
| Conditional recommendations | Most patients in this situation would want the suggested course of action, but many would not |
| Implications for clinicians | |
| Strong recommendations | Most patients should receive the intervention. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator |
| Conditional recommendations | Recognize that different choices will be appropriate for individual patients and that the clinician must help each patient arrive at a management decision consistent with his or her values and preferences. Decision aids may be useful in helping patients make decisions consistent with their values and preferences |
| Implications for policy makers | |
| Strong recommendations | The recommendation can be adapted as policy in most situations |
| Conditional recommendations | Policy making will require substantial debate and involvement of various stakeholders |