Table 1.
Interpreting strong and weak recommendations using the GRADE method9
| TARGET AUDIENCE | STRONG RECOMMENDATION* | WEAK RECOMMENDATION† |
|---|---|---|
| Patients or the public | We believe most people in this situation would want the recommended course of action and only a small number would not | We believe that most people in this situation would want the recommended course of action, but many would not; different choices are acceptable and clinicians should support patients and discuss values and preferences to reach decisions; decision aids might support people in reaching these decisions |
| Clinicians | The recommendation applies to most individuals; formal decision aids are not likely needed to help individuals make decisions consistent with their values and preferences | We recognize that different choices might be appropriate for individual patients; clinicians should support each patient in reaching a decision consistent with his or her values and preferences; decision aids might support individuals in reaching such decisions |
| Policy makers and developers of quality measures | The recommendation can be adopted as policy in most situations; adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator | Policy making will require substantial debate and involvement of various stakeholders. An appropriately documented decision-making process could be used as quality indicator |
GRADE—Grading of Recommendations Assessment, Development and Evaluation.
Strong recommendations are those for which we are confident that the desirable effects of an intervention outweigh its undesirable effects (strong recommendation for) or that the undesirable effects of an intervention outweigh its desirable effects (strong recommendation against).
Weak recommendations are those for which the desirable effects probably outweigh the undesirable effects (weak recommendation for) or undesirable effects probably outweigh the desirable effects (weak recommendation against) but uncertainty exists. Weak recommendations result when the difference between desirable and undesirable effects is small, the quality of evidence is lower, or there is more variability in the values and preferences of individuals.