Quality of Evidence Grades and Strength of Recommendations
Grade Definition
High We are very confident that the true effect lies close to that of the estimate of
the effect.
Moderate We are moderately confident in the effect estimate: e true effect is likely
to be close to the estimate of the effect, but there is a possibility that it is
substantially different
Low Our confidence in the effect estimate is limited: e true effect may be
substantially different from the estimate of the effect.
Very Low We have very little confidence in the effect estimate: e true effect is likely to
be substantially different from the estimate of effect
Implication of the strength of recommendation for different users of the guideline
Strong recommendation
Conditional (weak)
recommendation
Patients Most individuals in this situation
would want the recommended
course of action, and only a small
proportion would not.
e majority of individuals in this
situation would want the suggested
course of action, but many would not.
Clinicians Most individuals should receive
the intervention. Formal decision
aids are not likely to be needed to
help individuals 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 his or her values and preferences.
Decision aids may be useful in helping
individuals to make decisions consistent
with their values and preferences.
Policy
makers
e 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
would have to focus on the fact that
adequate deliberation about the
management options has taken place.