Summary
This article describes the Grading of Recommendations Assessment, Development, and
Evaluation (GRADE) approach to classifying the direction and strength of recommendations.
The strength of a recommendation, separated into strong and weak, is defined as the
extent to which one can be confident that the desirable effects of an intervention
outweigh its undesirable effects. Alternative terms for a weak recommendation include
conditional, discretionary, or qualified. The strength of a recommendation has specific
implications for patients, the public, clinicians, and policy makers. Occasionally,
guideline developers may choose to make “only-in-research” recommendations.
Although panels may choose not to make recommendations, this choice leaves those looking
for answers from guidelines without the guidance they are seeking. GRADE therefore
encourages panels to, wherever possible, offer recommendations.
Zusammenfassung
Der Artikel beschreibt den Grading of Recommendations Assessment, Development, and
Evaluation (GRADE)-Ansatz zur Klassifizierung der Richtung und Stärke von Empfehlungen.
Die Stärke der Empfehlung, die in stark und schwach eingeteilt werden kann, wird definiert
als das Ausmaß des Vertrauens, dass eine Intervention mehr wünschenswerte als unerwünschte
Folgen hat.
Alternative Bezeichnungen für eine schwache Empfehlung sind „bedingte Empfehlung”,
„Empfehlung, deren Umsetzung dem eigenen Ermessen überlassen ist” und „Empfehlung
mit Vorbehalt.“ Die Stärke einer Empfehlung hat spezifische Implikationen für Patienten,
die Öffentlichkeit, Kliniker und andere Entscheidungsträger. In manchen Fällen geben
Leitlinien-Entwickler Empfehlungen ab, die „only-in-research”-Empfehlungen sind, also
Empfehlungen, eine Intervention nur im Rahmen wissenschaftlicher Studien anzuwenden.
Eine Entscheidung, keine Empfehlung abzugeben, führt dazu, dass jene, die sich Antworten
von Leitlinien erhoffen, keine Hilfestellung erhalten. GRADE ermutigt Leitliniengremien
daher, wann immer es möglich ist, Empfehlungen auszusprechen.
Schlüsselwörter
Keywords
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Article info
Footnotes
☆Übersetzt und adaptiert von: Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y, Nasser M, Meerpohl J, Post PN, Kunz R, Brozek J, Vist G, Rind D, Akl EA, Schünemann HJ; GRADE Working Group. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations J Clin Epidemiol 66(2013)719-725.
Identification
Copyright
© 2014 Published by Elsevier Inc.
