Implications of strong and conditional recommendations, by guideline user
| Perspective | Strong recommendation (i.e., “We recommend that…” or “We recommend to not…”) | Conditional recommendation (i.e., “We suggest…” or “We suggest to not…”) |
|---|---|---|
| Authors | The net desirable effects of a course of action outweigh the effects of an alternative course of action. | It is less clear whether the net desirable consequences of a strategy outweigh the alternative strategy. |
| Patients | Most individuals in the situation would want the recommended course of action, while only a small proportion would not. | Many individuals in the situation would want the suggested course of action, but many would not. |
| Clinicians | Most individuals should receive the suggested course of action. Adherence to this course of action according to the guideline could be used as a quality criterion or performance indicator. | Recognize that patient choices will vary by individual. Patients must be helped to arrive at a care decision consistent with their values and preferences. |
| Policy-makers | The recommendation can be adapted as policy in most settings. | The recommendation can serve as a starting point for debate, with the involvement of many stakeholders. |
Adapted with permission from Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Schünemann H, Brozek J, Guyatt G, Oxman A, eds.; 2013.