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
GPS Good Practice Statements
Interpretation of Strong and Conditional Recommendations
Using the GRADE Framework
Implications Strong recommendation (S) Conditional recommendation (C)
For patients Most fully informed people
in this situation would want
to follow the recommended
course of action, and only a small
proportion would not.
e majority of fully informed people
in this situation would want the
suggested course of action, but many
would not, and a discussion between
them and their healthcare professional
may help reach a decision (i.e., shared
decision making ).
For clinicians Most individuals should receive
the intervention or test. Formal
decision aids are not likely to
be needed to help individual
patients 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 their values and
preferences. Decision aids may be
useful in helping individuals to make
decisions consistent with their values
and preferences. For each conditional
recommendation we provide key
conditions to guide working with
patients in choosing their best
treatment course.
For 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
about the suggested course of action
should focus on documentation
of appropriate decision-making
processes.
Strong recommendations are indicated by statements that lead with "we recommend," while
conditional recommendations are indicated by statements that lead with "e Joint Task
Force suggests."
