Table 1.

Strengths of Recommendations

From the GRADE working group	Recommendation (“We recommend . . .”)	Suggestion (“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.	The majority of individuals in this situation would want the suggested course of action, but a sizable minority would not.
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.	Different choices will be appropriate for different patients, and you 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.
For policy-makers	The recommendation can be adapted as policy in most situations, including for use as performance indicators.	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.
From the ATS/JRS/ALAT Diagnosis of Hypersensitivity Pneumonitis Guidelines panel discussion
	It is the right course of action for >95% of patients.	It is the right course of action for >50% of patients.
	“Just do it.”	“Slow down, think about it, discuss it with the patient.”
	You would be willing to tell a colleague who did not follow the recommendation that he/she did the wrong thing.	You would not be willing to tell a colleague who did not follow the recommendation that he/she did the wrong thing; it is “style” or “equipoise.”
	The recommended course of action may be an appropriate performance measure.	The recommended course of action is not appropriate for a performance measure.

Definition of abbreviations: ALAT = Asociación Latinoamericana del Tórax; ATS = American Thoracic Society; GRADE = Grading of Recommendations, Assessment, Development, and Evaluation; JRS = Japanese Respiratory Society.

The meaning of a suggestion is the same as a weak or conditional recommendation in typical GRADE nomenclature.