Table 4.

Interpretation of strong and conditional recommendations

Implications for	Strong recommendation	Conditional recommendation
Patients	• Most individuals in this situation would want the recommended course of action, and only a small proportion would not	• The majority of individuals in this situation would want the suggested course of action, but many would not • Decision aids may be useful in helping patients to make decisions consistent with their individual risks, values, and preferences
Clinicians	• Most individuals should follow the recommended course of action • Formal decision aids are not likely to be needed to help individual patients make decisions consistent with their values and preferences	• Recognize that different choices will be appropriate for individual patients and that you must help each patient arrive at a management decision consistent with their values and preferences • Decision aids may be useful in helping individuals to make decisions consistent with their individual risks, values, and preferences
Policy makers	• 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	• Policymaking will require substantial debate and involvement of various stakeholders • Performance measures should assess whether decision-making is appropriate
Researchers	• The recommendation is supported by credible research or other convincing judgments that make additional research unlikely to alter the recommendation • On occasion, a strong recommendation is based on low or very low certainty in the evidence • In such instances, further research may provide important information that alters the recommendations	• The recommendation is likely to be strengthened (for future updates or adaptation) by additional research • An evaluation of the conditions and criteria (and the related judgments, research evidence, and additional considerations) that determined the conditional (rather than strong) recommendation will help identify possible research gaps