A guide for health professionals to interpret and use recommendations in guidelines developed with the GRADE approach

Journal of Clinical Epidemiology
Ignacio NeumannGordon Guyatt

Abstract

An increasing number of organizations worldwide are using new and improved standards for developing trustworthy clinical guidelines. One of such approaches, developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group, offers systematic and transparent guidance in moving from evidence to recommendations. The GRADE strategy concentrates on four factors: the balance between benefits and harms, the certainty of the evidence, values and preferences, and resource considerations. However, it also considers issues around feasibility, equity, and acceptability of recommendations. GRADE distinguishes two types of recommendations: strong and weak. Strong recommendations reflect a clear preference for one alternative and should apply to all or almost all patients, obviating the need for a careful review of the evidence with each patient. Weak recommendations are appropriate when there is a close balance between desirable and undesirable consequences of alternative management strategies, uncertainty regarding the effects of the alternatives, uncertainty or variability in patients' values and preferences, or questionable cost-effectiveness. Weak recommendations usually require accessing the under...Continue Reading

References

Feb 19, 1999·BMJ : British Medical Journal·S H WoolfJ Grimshaw
Dec 22, 2006·The Lancet Infectious Diseases·Holger J SchünemannUNKNOWN WHO Rapid Advice Guideline Panel on Avian Influenza
Mar 5, 2008·Annals of Internal Medicine·Amir QaseemUNKNOWN American College of Physicians/American Academy of Family Physicians Panel on Dementia
Jun 9, 2010·The Journal of Clinical Endocrinology and Metabolism·Shalender BhasinUNKNOWN Task Force, Endocrine Society
Jul 27, 2010·Journal of Clinical Epidemiology·Melissa C BrouwersUNKNOWN AGREE Next Steps Consortium
Sep 8, 2010·The Journal of Allergy and Clinical Immunology·Jan L BrozekUNKNOWN Grading of Recommendations Assessment, Development and Evaluation Working Group
Jan 5, 2011·Journal of Clinical Epidemiology·Gordon GuyattHolger J Schünemann
Jan 6, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Alison G Freifeld Infectious Diseases Society of Americaa
Jan 25, 2011·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Alison G Freifeld Infectious Diseases Society of America
Apr 8, 2011·American Journal of Respiratory and Critical Care Medicine·Ganesh RaghuUNKNOWN ATS/ERS/JRS/ALAT Committee on Idiopathic Pulmonary Fibrosis
Feb 3, 2012·Journal of Clinical Epidemiology·Trudy van der WeijdenGlyn Elwyn
May 24, 2012·Journal of General Internal Medicine·Glyn ElwynMichael Barry
May 24, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Benjamin A Lipsky Infectious Diseases Society of America
Jun 21, 2013·The Journal of Clinical Endocrinology and Metabolism·Juan P BritoVictor M Montori
Jul 10, 2014·JAMA : the Journal of the American Medical Association·Mohammad Hassan MuradGordon Guyatt

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Citations

Apr 30, 2016·Environment International·Kristina A Thayer, Holger J Schünemann
Mar 30, 2017·Expert Review of Gastroenterology & Hepatology·Lynne V McFarland
Oct 19, 2016·Spine·Niccole M Germscheid, Charles G Fisher
Apr 8, 2017·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·M J LeeUNKNOWN ACPGBI Perianal Crohn's Disease Group
Jun 2, 2018·Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research·Shu-Fen SuYing-Chin Liao
Aug 2, 2018·Journal of Evaluation in Clinical Practice·Mathew Mercuri, Amiram Gafni
Jul 15, 2018·Research Synthesis Methods·Yuan ZhangHolger J Schünemann
Feb 15, 2018·Journal of Korean Medical Science·Ein Soon ShinYoon Seong Lee
Jul 12, 2019·Anaesthesia·G P JoshiUNKNOWN PROSPECT Working Group Collaborators
Oct 15, 2019·Anesthesia and Analgesia·Honorio T BenzonThomas R Vetter
Oct 16, 2018·Anesthesia and Analgesia·Richard D UrmanGirish P Joshi
Mar 11, 2020·European Journal of Oral Sciences·Clovis Mariano Faggion
Aug 10, 2019·Journal of Periodontology·Justine Hoda HaiGary C Armitage
Sep 18, 2020·Journal of Evaluation in Clinical Practice·Brian Baigrie, Mathew Mercuri
Jun 13, 2017·Journal of Pediatric Oncology Nursing : Official Journal of the Association of Pediatric Oncology Nurses·Deborah WoodsEmily Browne
Feb 18, 2020·Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis·Edwina A BrownBradley Warady
Aug 8, 2018·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Luca Bertolaccini, Gaetano Rocco
Nov 20, 2019·Anesthesia and Analgesia·Honorio T BenzonThomas R Vetter
Nov 30, 2019·Clinical Microbiology Reviews·Caryn BernJames H Maguire

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