en
Scientific article
English

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

Published inJournal of clinical epidemiology, vol. 72, p. 45-55
Publication date2016
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 underlying evidence and a shared decision-making approach. Clinicians using GRADE recommendations should understand the meaning of the strength of the recommendation, be able to critically appraise the recommendation, and apply trustworthy recommendations according to their strength.

Keywords
  • Decision Making
  • Education, Medical/methods/standards
  • Evidence-Based Medicine/standards
  • Female
  • Health Personnel/education
  • Humans
  • Male
  • Practice Guidelines as Topic/standards
  • Quality of Health Care
Citation (ISO format)
NEUMANN, Ignacio et al. A guide for health professionals to interpret and use recommendations in guidelines developed with the GRADE approach. In: Journal of clinical epidemiology, 2016, vol. 72, p. 45–55. doi: 10.1016/j.jclinepi.2015.11.017
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Article (Published version)
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ISSN of the journal0895-4356
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