Table 3.

Strength of recommendations (adapted from GRADE and ESHRE Manual)

Target group	Strong recommendationsa	Conditional (weak) recommendations for the option (test or treatment)	Conditional (weak) recommendation for either the option or the comparison	Research-only recommendations	Clinical practice pointsb
Consumers	Most people in your situation would want the recommended course of action and only a small proportion would not	The majority of people in your situation would want the recommended course of action but some would not	There is considerable lack of clarity over whether the majority of people in your situation would want the recommended course of action or not	The test or intervention should only be considered by patients and clinicians within the setting of a research trial for which appropriate approvals and safety precautions have been established	Clinicians, patients and policy-makers are informed on the clinical implications relevant to implementation of recommendations
Health professionals	Most patients should receive the recommended course of action	Recognise that different choices will be appropriate for different patients and that greater effort is needed with individuals to arrive at management decisions consistent with values and preferences Decision aids and shared decision-making are important here		The test or intervention should only be considered by patients and clinicians within the setting of a research trial for which appropriate approvals and safety precautions have been established
Policy-makers	The recommendation can be adopted as policy in most situations	Policy-making needs to consider perspectives and involvement of diverse stakeholders	Policy decisions remain unclear	Policy-makers need to be aware of the need for evidence gaps and health professional and consumer-prioritised research gaps

^a Strong recommendations based on high quality evidence will apply to most patients for whom these recommendations are made, but they may not apply to all patients in all conditions; no recommendation can take into account all of the often-compelling unique features of individual patients and clinical circumstances

^b A clinical practice point is developed by the Guideline Development Group to support recommendations; advice can be provided to enhance shared decision-making and on factors to be considered in implementing a specific test or intervention