title: GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength.
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.
authors.affiliation: Vanderbilt Evidence-based Practice Center, Vanderbilt University, #27166-719 Thompson Lane, Nashville, TN 37204-3195, USA. jeff.andrews@vanderbilt.edu
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Andrews
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Oxman
authors.forename: Kevin
authors.initials: K
authors.lastname: Pottie
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
authors.forename: Pablo Alonso
authors.initials: PA
authors.lastname: Coello
authors.forename: David
authors.initials: D
authors.lastname: Rind
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Brito
authors.forename: Susan
authors.initials: S
authors.lastname: Norris
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Elbarbary
authors.forename: Piet
authors.initials: P
authors.lastname: Post
authors.forename: Mona
authors.initials: M
authors.lastname: Nasser
authors.forename: Vijay
authors.initials: V
authors.lastname: Shukla
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Jan
authors.initials: J
authors.lastname: Brozek
authors.forename: Ben
authors.initials: B
authors.lastname: Djulbegovic
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: D002170:Canada; D019317:Evidence-Based Medicine / Q000592:standards*; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology / Q000534:rehabilitation*; D011785:Quality Assurance, Health Care; D012107:Research Design / Q000592:standards; D018570:Risk Assessment; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States