Commentary
Guideline panels should not GRADE good practice statements

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Reservations regarding good practice statements

A word of caution is required: good practice statements may be subject to abuse. They potentially allow guideline panels to issue strong recommendations that may be unwarranted (which guideline panels seem prone to do [2], [3]) and to do so without the intellectual work that formally applying the GRADE process demands. Furthermore, judgments about what are incontestable net benefits are inevitably subjective. Thus, good practice statements represent a temptation, and panels should therefore use

Conclusion

We suggest that guideline panellists can best understand GRADE principles and apply these principles to the recognition of recommendations that warrant good practice statements rather than rigorous application of GRADE, by asking themselves how certain they are in estimates of effect. When they have a high level of certainty in these estimates based on the previously mentioned principles, they will also be confident that the associated clinical actions will do more good than harm, or vice

Acknowledgments

The authors thank Andy Oxman, Susan Norris, and Roman Jaeschke for their insightful suggestions on a draft version of this article and Paul Alexander for identifying the World Health Organization recommendations we have used as examples.

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Disclaimer: This article represents the views of the authors and does not constitute official GRADE working group guidance.

Conflict of interest: None of the authors has any financial conflict of interest to disclose. All authors are members of the GRADE working group.

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