Summary: This presentation will summarize the GRADE working group's approach to developing recommendations on the basis of the best available evidence.

Abstract: The GRADE working group offers an approach to moving from evidence to recommendations.  In this approach recommendations are either in favor of a particular intervention in comparison to an alternative, or against that intervention.  The strength of the recommendation can take one of two levels, most commonly designated as “strong” and “weak”.

The strength of a recommendation reflects the extent to which we can be confident that desirable effects of an intervention outweigh undesirable effects.  Effects of an intervention include reduction or increase in morbidity and mortality, improvement or deterioration in quality of life, and or increase in the burden of treatment and reduced or increased resource expenditures.

The implications of a strong recommendation are that most patients should receive the recommen ded course of action and for policy makers.  For policy makers strong recommendations are candidates for quality of care criteria. A weak recommendation implies that, depending on the circumstances and patients’ values and preference, the recommended course of action may not be best for all patients.  Weak recommendations are good candidates for use of formal decision aids.

Two key factors may downgrade the strength of a recommendation.  One is low quality evidence.  The other is a close balance between the desirable and undesirable consequences of the intervention.