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: Donau-Universität Krems, Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Krems, Österreich. Electronic address: barbara.nussbaumer@donau-uni.ac.at.
authors.forename: Barbara
authors.initials: B
authors.lastname: Nußbaumer
authors.affiliation: Donau-Universität Krems, Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Krems, Österreich.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gartlehner
authors.affiliation: Donau-Universität Krems, Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Krems, Österreich.
authors.forename: Christina
authors.initials: C
authors.lastname: Kien
authors.affiliation: Donau-Universität Krems, Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Krems, Österreich.
authors.forename: Angela
authors.initials: A
authors.lastname: Kaminski-Hartenthaler
authors.affiliation: Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
authors.forename: Gero
authors.initials: G
authors.lastname: Langer
authors.affiliation: Deutsches Cochrane Zentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University Health Science Centre, Hamilton, Kanada.
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D032921:Consensus; D019317:Evidence-Based Medicine / Q000592:standards*; D006295:Health Resources / Q000592:standards; D006801:Humans; D009313:National Health Programs / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D016896:Treatment Outcome
keywords: Empfehlungen; Evidenz; GRADE; Leitlinienentwicklung; Qualität der Evidenz; Stärke der Evidenz; evidence; guideline development; quality of evidence; recommendation; strength of evidence