Table 3 Implications of strong and weak recommendations for different end-users

For patients

Most individuals in this situation would want the recommended course of action and only a small proportion would not.

The majority of individuals in this situation would want the suggested course of action, but many would not.

For clinicians

Most individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.

Recognize that different choices will be appropriate for different patients, and that you must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may well be useful helping individuals making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working towards a decision.

For policy-makers

The recommendation can be used to develop policy (e.g. tax on products high in sugar or salt)

Policy-making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place.