Table 5.

GRADE strength of recommendation classifications and interpretation

Strength of recommendation	Criteria	Interpretation by patients	Interpretation by healthcare providers	Interpretation by policymakers
1—Strong recommendation for or against	Desirable consequences clearly outweigh the undesirable consequences in most settings (or vice versa)	Most individuals in this situation would want the recommended course of action, and only a small proportion would not.	Most individuals should receive 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.	The recommendation can be adopted as policy in most situations. Adherence to this recommendation according to the guidelines could be used as a quality criterion or performance indicator.
2—Conditional recommendation for or against	Desirable consequences probably outweigh undesirable consequences in most settings (or vice versa)	The majority of individuals in this situation would want the suggested course of action, but many would not.	Clinicians should recognize that different choices will be appropriate for each individual and that clinicians must help each individual arrive at a management decision consistent with the individual’s values and preferences. Decision aids may be useful in helping patients make decisions consistent with their individual risks, values and preferences.	Policymaking will require substantial debate and involvement of various stakeholders.   Performance measures should assess whether decision making is appropriate.

Source: Adapted from Schünemann HJ et al. Blood Adv, 2018; 2(22) © by The American Society of Hematology (136).