Certainty in the Evidence
H=High High confidence that the estimated effect is close to the true effect.
M=Moderate
Moderate confidence that the estimated effect is close to the true effect, but
with a chance that the true effect is considerably different.
L=Low Low confidence in the estimated effect. Higher likelihood that the true
effect is considerably different from the estimated effect.
VL=Very Low Very low confidence in the estimated effect. High likelihood that the true
effect is considerably different from the estimated effect.
Grading of Recommendations, Assessment, Development, and
Evaluation (GRADE)-Based Recommendations
Implications
for: S=Strong Recommendation C=Conditional Recommendation
Patients e majority of patients would
want the recommended course
of action in this situation, and
only a small number would not.
Many patients in this situation would
prefer the recommendation, but a
substantial number may not. is is an
opportunity for shared decision-making
between the clinician and patient.
Clinicians
Most individuals should receive
the course of action that is
recommended. ere is a low
chance that additional formal
decision aids are needed to
help individuals make decisions
consistent with their values and
preferences, and adherence to
this recommendation could be
used as a performance indicator
or quality criterion.
Different choices will be applicable to
different patients, and additional factors
will need to be considered in addition
to the recommendation in order for a
patient to make a decision according to
their values and preferences. Decision
aids may be needed to assist individuals
in making their best choice. is is an
opportunity for shared decision-making
between the clinician and patient.
Policy Makers e recommendation can be
widely adapted as policy and
can be used for performance
indicators.
Policy-making will require substantial
additional debate and involvement of
many and/or additional stakeholders.
e likelihood of regional variance is
also higher, and performance indicators
would need to take into consideration
any additional deliberation that has
occurred.
