RNAO BPGs are developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method.
Certainty of Evidence
The certainty of evidence (i.e., the level of confidence we have that an estimate of effect is true) for quantitative research is determined using GRADE methods (12). After synthesizing the evidence for each prioritized outcome, the certainty of evidence is assessed. The overall certainty of evidence is determined by considering the certainty of evidence across all prioritized outcomes per recommendation. GRADE categorizes the overall certainty of evidence as high, moderate, low or very low. See Table 1 for definitions of these categories.
Table 1: Certainty of Evidence
|
Certainty of Evidence |
Definition |
|
High |
We are very confident that the true effect lies close to that of the estimate of the effect. |
|
Moderate |
We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. |
|
Low |
Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. |
|
Very low |
We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. |
Source: Reprinted from The GRADE Working Group. Quality of evidence. In: Schunemann H, Brozek J, Guyatt G, et al., editors. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach [Internet]. [place unknown; publisher unknown]; 2013. Table 5.1, Quality of evidence grades. Available from: https://gdt.gradepro.org/app/handbook/handbook.html#h.wsfivfhuxv4r. Reprinted with permission.
Note: The assigned certainty of evidence can be found directly below each recommendation statement. For more information on the process of determining the certainty of evidence and the documented decisions made by the RNAO Guideline Development Methodologists, please see Appendix C.
Strength of Recommendations
Recommendations are formulated as strong or conditional by considering the certainty of evidence and the following key criteria:
- balance of benefits and harms,
- values and preferences, and
- health equity.
Strong Recommendation
“A strong recommendation reflects the expert panel’s confidence that the desirable effects of an intervention outweigh its undesirable effects (strong recommendation for an intervention) or that the undesirable effects of an intervention outweigh its desirable effects (strong recommendation against an intervention)” (12). A strong recommendation implies that the majority of persons will be best served by the recommended action (12).
Conditional Recommendation
A conditional recommendation reflects the expert panel’s confidence that while some uncertainty exists, the desirable effects probably outweigh the undesirable effects (i.e., conditional recommendation for an intervention) or that the undesirable effects probably outweigh the desirable effects (i.e., a conditional recommendation against an intervention) (12). A conditional recommendation implies that not all persons will be best served by the recommended action and that “there is a need for more careful consideration of personal circumstances, preferences and values” (12).
Note: The strength of the recommendation statement is detailed directly below each recommendation statement and within the Summary of Recommendations.