Table 4.

Society for integrative oncology level of certainty of recommendations*

Level of certainty**	Description
High	The available evidence usually includes consistent results from well-designed, well-conducted studies in representative breast cancer patient populations. These studies assess the effects of the modality and conclusion is therefore unlikely to be strongly affected by the results of future studies.
Moderate	The available evidence is sufficient to determine the effects of the modality on health outcomes, but confidence in the estimate is constrained by such factors as: the number, size, or quality of individual studies; inconsistency of findings across individual studies; limited generalizability of findings to routine breast oncology practice; and lack of coherence in the chain of evidence. As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.
Low	The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of: the limited number or size of studies; important flaws in study design or methods; inconsistency of findings across individual studies; gaps in the chain of evidence; findings that are not generalizable to routine breast oncology practice; and a lack of information on important health outcomes. More information may allow an estimation of effects on health outcomes.

* Adapted from US Preventive Services Task Force (31).

** Certainty is defined as “likelihood that the Society for Integrative Oncology Guidelines Working Group assessment of the net benefit of a supportive care service is correct.” The net benefit is defined as benefit minus harm of the supportive care service as implemented in a general breast oncology population. The Society for Integrative Oncology Guidelines Working Group assigns a certainty level on the basis of the nature of the overall evidence available to assess the net benefit of a supportive care service.