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Guidelines contain recommendations about what action patients, healthcare professionals and policymakers should take. Guidelines also include other useful information (such as evidence) to help people make decisions about health. Evidence should be provided, but also how certain we are about that evidence should be described (see “What is Certainty of Evidence?”).

A recommendation is an actionable statement. It describes an action. For example, a recommendation could say “the guideline group recommends Drug A to treat the common cold.” The action is to provide Drug A when treating the common cold.

It is important to note that recommendations are not just about what medications to take. For example, during COVID, there were recommendations about social distancing and using rapid tests at home. Recommendations can be about many different topics, not just about treatments and drugs.

Included with a recommendation is the strength of the recommendation. To learn more about recommendation strength, see “What is Certainty of Evidence?”

No. It simply means that we may need to consider the factors a little more because they may be different in certain situations. For example, Drug A may not be available or more expensive in some situations, and so another drug may be better to use.

The order in which sets of recommendations are shared, as well as the order in which they are presented within each set, does not indicate an order of importance. The CAN-PCC Collaborative shares draft recommendations as soon as they are formulated. Eventually, the CAN-PCC Collaborative will release recommendations for around 90 questions that were selected as being important.

A systematic review is a review of studies that have been done. This review can answer a question about what should be done. For example, “should we recommend Drug A to treat the common cold?” We will then determine the certainty of evidence, or how sure we are that the results from the review of studies are the true effects of the drug. See “What is Certainty of Evidence?” to learn more.

 

Let’s say we’re picking a restaurant for dinner. We decide to read customer reviews to help with our decision. Should we believe those customer reviews? Maybe the better the reviews, the more certain we are that the restaurant is good. It is the same when recommending drugs. We review scientific studies to find out how good the drug is. The review will give us some results. Certainty of Evidence is how sure we are that the results from the review of studies are the true effects of the drug. Or, how sure we are that the customer reviews are the true quality of the restaurant. Our certainty can go from High to Very Low.

We use a system called GRADE that tells us how to decide on the certainty. GRADE is a standard in guideline development. It is the method that guidelines groups use to assess the certainty and develop recommendations. The GRADE working group was created through the influence of many guideline organizations such as the World Health Organization (WHO), the National Institute for Health and Care Excellence (NICE), and the Centers for Disease Control and Prevention (CDC). Over 100 organizations help to develop and use GRADE.

Learn about McMaster’s GRADE centre.