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
Stakeholder Strong Recommendation Conditional Recommendation
Patient Most individuals in this
situation would want the
recommended course of action,
and only a small proportion
would not.
The majority of individuals in this
situation would want the suggested
course of action, but some would not.
Clinician Most individuals should receive
the intervention. Adherence to
this recommendation according
to the guideline could be
used as a quality criterion or
performance indicator. 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 their values and
preferences. Decision aids may be
useful in helping individuals to make
decisions consistent with their values
and preferences.
Policy-maker The recommendation can
be adopted as policy in most
situations.
Policy making will require substantial
debate and involvement of various
stakeholders.
