Table 15.
Determining strength of action for key guideline statements
| Statement | Definition | Implication |
|---|---|---|
| Strong Recommendation |
A strong recommendation means the benefits of the recommended approach clearly exceed the harms (or, in the case of a strong negative recommendation, that the harms clearly exceed the benefits) and that the quality of the supporting evidence is excellent (Grade A or B)*. In some clearly identified circumstances, strong recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms. |
Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. |
| Recommendation | A recommendation means the benefits exceed the harms (or, in the case of a negative recommendation, that the harms exceed the benefits), but the quality of evidence is not as strong (Grade B or C)*. In some clearly identified circumstances, recommendations may be made based on lesser evidence when high- quality evidence is impossible to obtain and the anticipated benefits outweigh the harms. |
Clinicians should also generally follow a recommendation, but should remain alert to new information and sensitive to patient preferences. |
| Option | An option means that either the quality of evidence is suspect (Grade D)* or that well- done studies (Grade A, B, or C)* show little clear advantage to one approach versus another. |
Clinicians should be flexible in their decision making regarding appropriate practice, although they may set bounds on alternatives; patient preference should have a substantial influencing role |