Table 2

Decisions about the strength of a recommendation

Factors that can weaken the strength of a recommendation
Explanation

Lower quality evidence
Will create greater uncertainty about the size of the (relative) effects (benefits and harms)
Uncertainty about the balance of benefits versus harms and burdens
Uncertainty about the baseline risk, prevalence of a problem or health status, which could affect the size of the (absolute) effects
Uncertainty or differences in values
Uncertainty about the relative importance of the benefits and downsides to those affected, or differences in how important they are to different people, which could affect the balance between the benefits versus harms and burden
Marginal net benefits or downsides
The anticipated net benefits or downsides are small (and uncertain)
Uncertainty about whether the net benefits are worth the costs
Uncertainty related to lack of information about the cost or whether the resource expenditure is justified by the anticipated benefit

Schünemann et al. Health Research Policy and Systems 2006 4:21   doi:10.1186/1478-4505-4-21