2
Interpretation of the Certainty in Evidence of Effects using
the GRADE framework
H = High We are very confident that the true effect lies close to that of the
estimate of the effect.
M = 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.
L = Low Our confidence in the effect estimate is limited. e true effect may
be substantially different from the estimate of the effect.
VL = 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
Interpretation of Strong and Conditional Recommendations
using the GRADE framework
Implications
S = Strong
recommendation C = Conditional recommendation
For 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.
For 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.
Different choices will be appropriate for
individual patients consistent with his or
her values and preferences. Use shared-
decision making. Decision aids may be
useful in helping patients make decisions
consistent with their individual risks,
values and preferences.
For policy
makers
e recommendation can
be adapted as policy or
performance measure in
most situations
Policy-making will require substantial
debate and involvement of various
stakeholders. Performance measures
should assess whether decision making is
appropriate.
* Strong recommendations are indicated by statements that lead with "recommend", while conditional
recommendations are indicated by statements that lead with "suggest"
