GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations

Andrews, Jack R.; Guyatt, Gordon; Oxman, Andrew D; Alderson, Phil; Dahm, Philipp; Falck‐Ytter, Yngve; Nasser, Mona; Meerpohl, Joerg J; Post, Piet N.; Kunz, Regina; Brožek, Jan; Vist, Gunn Elisabeth; Rind, David M.; Akl, Elie A.; Schünemann, Holger J.

doi:10.1016/j.jclinepi.2012.03.013

Cited by 1,140 publications

(1,005 citation statements)

References 29 publications

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“…The quality of evidence is a measure of the confidence that is considered along with the size and direction of an effect [13], and it is a key component in determining the strength of recommendations made based on that evidence [7]. GRADE simplifies the classification of evidence quality/confidence in estimates of effect by assigning a body of evidence for a given outcome to high, moderate, low or very low categories.…”

Section: How Grade Workmentioning

confidence: 99%

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

“…Guidelines produced using the GRADE methodology result in recommendations that are strongly for (benefits clearly outweigh the harms), weakly for (developers less confident in positive balance of consequences), weakly against or strongly against an intervention [13]. To avoid target users conflating weak recommendations with weak evidence, the word ''weak'' is sometimes replaced with conditional or discretionary [13]. In order to minimize confusion, in addition to stating that a recommendation is either strong or weak, the number ''1'' is sometimes used to signify a strong recommendation, and the number ''2'' is used to signify a weak recommendation, though pictorial systems may be employed instead [13].…”

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

“…To avoid target users conflating weak recommendations with weak evidence, the word ''weak'' is sometimes replaced with conditional or discretionary [13]. In order to minimize confusion, in addition to stating that a recommendation is either strong or weak, the number ''1'' is sometimes used to signify a strong recommendation, and the number ''2'' is used to signify a weak recommendation, though pictorial systems may be employed instead [13]. As per GRADE methodology, the guideline developers make a strong recommendation when they believe that all or almost all informed patients would accept the recommended choice for or against an intervention, whereas the guideline developers make a weak recommendation when they believe that most informed people would make the recommended choice, but a substantial number would not [13].…”

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

“…In order to minimize confusion, in addition to stating that a recommendation is either strong or weak, the number ''1'' is sometimes used to signify a strong recommendation, and the number ''2'' is used to signify a weak recommendation, though pictorial systems may be employed instead [13]. As per GRADE methodology, the guideline developers make a strong recommendation when they believe that all or almost all informed patients would accept the recommended choice for or against an intervention, whereas the guideline developers make a weak recommendation when they believe that most informed people would make the recommended choice, but a substantial number would not [13]. When weak recommendations are made, the clinician is obliged to spend extra time assessing the specifics of the patient's case, discussing the costs and benefits of the intervention with the patient, determining the patient's perspective and attitude toward the intervention, and involving the patient in the decision on whether or not the intervention is warranted.…”

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

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Guidelines helping clinicians make the GRADE

Bayat

Lang

2014

Intern Emerg Med

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Section: How Grade Workmentioning

confidence: 99%

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

Section: What Clinicians Must Know About Gradementioning

confidence: 99%

See 3 more Smart Citations

Guidelines helping clinicians make the GRADE

Bayat

Lang

2014

Intern Emerg Med

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Breast Cancer Screening for Women at Average Risk

Oeffinger

Fontham

Etzioni

et al. 2015

JAMA

1,439

906

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Importance Breast cancer is a leading cause of premature mortality among U.S. women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. This report updates the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. Process The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update, and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. Evidence Synthesis Mammography screening in women aged 40–69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening in women who are age 70 years and older and are in good health. Estimates of the cumulative lifetime risk of false positive exams are greater if screening begins at younger ages due to the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs. biennially. Evidence does not support routine clinical breast examination as a screening method for average risk women. Recommendations The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women who are ages 45 to 54 years should be screened annually (qualified recommendation). Women who are age 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

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