A framework to evaluate the quality of evidence and facilitate shared decision making
GRADE is a framework for transparently rating the quality of the evidence and making recommendations based upon that assessment of quality. This transparent framework helps identify situations where evidence, values, or preferences are uncertain and highlights opportunities for shared decision making (SDM). The quality of evidence and the confidence we can have in that evidence is rated on a scale from very low to high and this rating is influenced by several factors. Starting with study design which benchmarks the confidence we can have in the evidence, evidence can then be rated down or rated up. Factors used to rate down include: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Factors used to rate up include: large effects, dose response, and confounding. After rating, recommendations can be made and strength assigned as either strong or conditional. Conditional recommendations particularly indicate a situation where SDM is appropriate.
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