A recommendation can be strong or conditional depending on the extent to which one can be confident that the desirable effects of an intervention or option outweigh their undesirable consequences.
The strength of a recommendation has specific implications for patients, the public, clinicians, policy-makers and researchers.
When a recommendation is strong
- For patients*: most individuals in this situation would want the recommended course of action, and only a small proportion would not.
- For clinicians: most individuals should follow the recommended course of action. Formal decision aids are not likely to be needed to help individual patients make decisions consistent with their values and preferences.
- For policy makers: the 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.
- For researchers: the recommendation is supported by credible research or other convincing judgments that make additional research unlikely to alter the recommendation. On occasion, a strong recommendation is based on low or very low certainty in the evidence. In such instances, further research may provide important information that alters the recommendations
When wording recommendations, those that are strong are worded as "the ECIBC's Guidelines Development Group recommends...".
When a recommendation is conditional
- For patients*: the majority of individuals in this situation would want the suggested course of action, but many would not. Decision aids may be useful in helping patients to make decisions consistent with their individual risks, values, and preferences.
- For clinicians: different choices will be appropriate for individual patients, and clinicians must help each patient arrive at a management decision consistent with the patient's values and preferences. Decision aids may be useful in helping individuals to make decisions consistent with their individual risks, values, and preferences.
- For policy makers: policy making will require substantial debate and involvement of various stakeholders. Performance measures about the suggested course of action should focus on whether an appropriate decision-making process is duly documented.
- For researchers: this recommendation is likely to be strengthened (for future updates or adaptation) by additional research. An evaluation of the conditions and criteria (and the related judgments, research evidence, and additional considerations) that determined the conditional (rather than strong) recommendation will help to identify possible research gaps.
When wording recommendations, those that are conditional are worded as "the ECIBC's Guidelines Development Group suggests...".
* Women in the case of screening
(Interpretation as suggested from GRADE Handbook)