Table 1

Recommendation classification, definition and examples of terminology for each classification

Recommendation classificationDefinitionExamples of terminology
‘Should do’‘Should do’ recommendations were those that should be applied in all circumstances unless there is a rationale not to. These were based on strong evidence, for example, multiple high-quality studies reporting clinically relevant positive effects, benefits that outweigh risks or when in the opinion of CPG development group members that the benefits were unequivocal.‘Strong recommendation’, for example,31 ‘offer’25 27 and ‘should’ occur.23 26
‘Could do’‘Could do’ recommendations could be applied depending on the circumstances of individual patients. They were usually based on consistent evidence from multiple lesser quality studies or one high quality study and where benefits outweigh harms.‘Considered’, for example,23 25 29 ‘may include’,26 ‘recommend’, ‘practitioner might’ and ‘suggest’.21
‘Do not do’‘Do not do’ recommendations applied when there was strong evidence of no benefit and/or harms outweighing benefits. Two CPGs provided strong and weak ‘do not do’ recommendations29 30 that were combined for the purposes of our review.‘Do not offer’, for example,27 29 ‘should refrain from’,28 ‘do not routinely offer’,29 ‘not appropriate’22 and ‘should not’.28
‘Uncertain’‘Uncertain’ applied when there was no recommendation for or against a practice, because of incomplete or inconsistent research findings. Not all CPGs provided uncertain recommendations.‘Inconclusive’ or ‘we are unable to recommend for or against’,21 ‘inconclusive evidence’27 or ‘uncertain’.22
  • CPGs, clinical practice guidelines.