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. 2020 May 1;201(9):e56–e69. doi: 10.1164/rccm.202003-0625ST

Table 1.

Implications of Strong and Conditional Recommendations: From the Grading of Recommendations, Assessment, Development, and Evaluation Working Group

  Strong Recommendation
(“We recommend . . .”)		 Conditional Recommendation
(“We suggest . . .”)
For patients The overwhelming majority of individuals in this situation would want the recommended course of action, and only a small minority would not. (It is the right course of action for >95% of patients.) The majority of individuals in this situation would want the suggested course of action, but a sizable minority would not. (It is the right course of action for >50% of patients.)
For clinicians The overwhelming majority of individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. (It is reasonable to recommend it strongly to patients and caregivers.) Different choices will be appropriate for different patients, and the clinician must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may be useful to help individuals make decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision. (Slow down, think about it, discuss it with the patient.)
For policy makers The recommendation can be adopted as policy in most situations, including for use as a performance indicator. (The recommended course of action may be an appropriate performance measure.) Policy making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place. (The recommended course of action is not appropriate for a performance measure.)