Treatment
Certainty of Evidence
Certainty Meaning
High There is a high level of confidence that the true effect is close to the estimated
effect.
Moderate There is a moderate level of confidence in the effect estimate; the true effect
is probably close to the estimated effect.
Low The confidence in the effect estimate is limited; the true effect may be
substantially different from the estimated effect.
Very Low There is very little confidence in the effect estimate; the true effect is
probably substantially different from the estimated effect
Strength of Recommendation
Stakeholders Strong Recommendation Conditional Recommendation
Patients Nearly all individuals in this
situation would want the
recommended course of action;
only a small proportion would
not.
The majority of individuals in this
situation would want the suggested
course of action, but many would
not.
Clinicians Most patients should receive
the recommended course of
action. Adherence to this
recommendation could be
used as a quality criterion or
performance indicator.
Different choices will be
appropriate for different patients.
The clinician must help patients
arrive at management decisions
consistent with their preferences
and values. Clinicians should expect
to spend more time with patients
when working towards a decision.
Policy Makers The recommendation can
be adapted as policy in most
situations. Quality improvement
initiatives could use adherence
to this recommendation as a
performance indicator.
Policy making will require
substantial debate and involvement
of many stakeholders. Policies
may also vary between regions and
health systems.
