Table 1

GRADE system—strength of recommendation18

Recommendation strengthGDG consensusInterpretation for clinicians
Strong recommendationThe GDG was confident that the desirable effects of adhering to the recommendation outweigh the undesirable effectsAll or almost all individuals would want the recommended course of action, and only a small proportion would not; therefore.
Weak (conditional) recommendationThe GDG concluded that the desirable effects of adhering to the recommendation probably outweigh the undesirable effects, but the group is not confident about these trade-offs.Most individuals would want the suggested course of action, but many would not.
In both cases, clinicians should recognise that different choices will be appropriate for individual patients, and that they must help each patient arrive at a management decision consistent with their values and preferences. In the case of a weak recommendation, variation in patient values and preferences are likely to be greater and therefore, healthcare providers need to devote more time to the process of shared decision making, by which they ensure that the informed choice reflects individual values and preferences.
  • GDG, guideline development group; GRADE, Grading of Recommendations Assessment, Development and Evaluation.