GRADE guidelines: 15. Going from evidence to recommendation - Determinants of a recommendation's direction and strength

Jeffrey C. Andrews, Holger J. Schünemann, Andrew D. Oxman, Kevin Pottie, Joerg J. Meerpohl, Pablo Alonso Coello, David Rind, Victor M. Montori, Juan Pablo Brito, Susan Norris, Mahmoud Elbarbary, Piet Post, Mona Nasser, Vijay Shukla, Roman Jaeschke, Jan Brozek, Ben Djulbegovic, Gordon Guyatt

Research output: Contribution to journalArticle

499 Scopus citations

Abstract

In the GRADE approach, the strength of a recommendation reflects the extent to which we can be confident that the composite desirable effects of a management strategy outweigh the composite undesirable effects. This article addresses GRADE's approach to determining the direction and strength of a recommendation. The GRADE describes the balance of desirable and undesirable outcomes of interest among alternative management strategies depending on four domains, namely estimates of effect for desirable and undesirable outcomes of interest, confidence in the estimates of effect, estimates of values and preferences, and resource use. Ultimately, guideline panels must use judgment in integrating these factors to make a strong or weak recommendation for or against an intervention.

Original languageEnglish (US)
Pages (from-to)726-735
Number of pages10
JournalJournal of Clinical Epidemiology
Volume66
Issue number7
DOIs
StatePublished - Jul 1 2013

Keywords

  • Evidence
  • GRADE
  • Guideline development
  • Quality of evidence
  • Recommendation
  • Strength of evidence

ASJC Scopus subject areas

  • Epidemiology

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    Andrews, J. C., Schünemann, H. J., Oxman, A. D., Pottie, K., Meerpohl, J. J., Coello, P. A., Rind, D., Montori, V. M., Brito, J. P., Norris, S., Elbarbary, M., Post, P., Nasser, M., Shukla, V., Jaeschke, R., Brozek, J., Djulbegovic, B., & Guyatt, G. (2013). GRADE guidelines: 15. Going from evidence to recommendation - Determinants of a recommendation's direction and strength. Journal of Clinical Epidemiology, 66(7), 726-735. https://doi.org/10.1016/j.jclinepi.2013.02.003