Certainty of Evidence
Evidence Quality Definition
High High confidence that the estimated effect is close to the true effect.
Moderate Moderate confidence that the estimated effect is close to the true effect,
but with a chance that the true effect is considerably different.
Low Low confidence in the estimated effect. Higher likelihood that the true
effect is considerably different from the estimated effect.
Very low Very low confidence in the estimated effect. High likelihood that the
true effect is considerably different from the estimated effect.
Implications of Clinical Guideline Recommendations by Stakeholder
Stakeholder Strong Recommendation Conditional Recommendation
Patient The 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. This is an
opportunity for shared decision-making
between the clinician and patient.
Clinician Most individuals should receive
the course of action that is
recommended. There 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. This is an
opportunity for shared decision-making
between the clinician and patient.
Policy-maker The 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.
The likelihood of regional variance is
also higher, and performance indicators
would need to take into consideration
any additional deliberation that has
occurred.
