Table 5 Implications of strength of recommendation for different users of guidelines

Definition

A guideline panel is confident that the desirable effects (benefits) of an intervention outweigh undesirable effects (harms, burden, and costs), or vice versa.

Desirable effects (benefits) of an intervention probably outweigh the undesirable effects (harms, burden, and costs), or vice versa, but the panel is less confident.

For patients

Most individuals in this situation would want the recommended course of action, and only a small proportion would not.

Many individuals in this situation may or may want the suggested course of action.

For clinicians

Most individuals should receive the intervention. Adherence to this recommendation according to the guidelines could be used as a quality criterion or performance indicator. Formal decision-making 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 different patients, and that you must help each patient arrive at a management decision consistent with her or his values and preferences. Decision-making aids may well be useful in helping individuals to make decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision.

For policy makers

The recommendation can be adapted as a policy in most situations, including for the use as performance indicators.

Policy-making will require substantial debates and involvement of many stakeholders. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place.