Recommendations are formulated as strong or conditional by considering the certainty and/or confidence in evidence, and the following key criteria:
- balance of benefits and harms
- values and preferences
- 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)” (11). A strong recommendation implies that the majority of persons will be best served by the recommended action (11).
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., a conditional recommendation for an intervention) or that the undesirable effects probably outweigh the desirable effects (i.e., conditional recommendation against an intervention) (11). A conditional recommendation implies that not all persons will be best served by the recommended action: “there is a need for more careful consideration of personal circumstances, preferences and values” (11).