Early-Onset Colorectal (Bowel) Cancer

Clinical Practice Guidelines

Recommendation Strength

When assessing the quality of the evidence for any given topic, each recommendation is given a rating known as a Strength. This helps the reader understand if the benefits of the intervention are greater than the disadvantages. We have used the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation) to determine the Strength of the recommendations.

The GRADE framework uses the following:

  • Strength Indicator: Strong recommendations for the interventionStrong recommendations for the intervention

There is high or moderate certainty evidence that an intervention provides a net benefit.

  • Strength Indicator: Strong recommendation against the interventionStrong recommendation against the intervention

There is high or moderate certainty evidence that it results in a net harm.

  • Strength Indicator: Conditional recommendation for the interventionConditional recommendation for the intervention

There is uncertainty about the net effect of an intervention compared with the alternative but is deemed to be possibly beneficial. This may be due to limited evidence, variability in values on outcomes, evidence suggesting similarly weighted benefits and harms.

  • Strength Indicator: Conditional recommendation againstConditional recommendation against the intervention

There is uncertainty about the net effect of an intervention compared with the alternative but is deemed to be possibly harmful. This may be due to limited evidence, variability in values on outcomes, evidence suggesting similarly weighted benefits and harms.

  • Strength Indicator: Good practice statementConsensus recommendation

Evidence is absent or of insufficient certainty; or there is an unclear balance between benefits and harms. A decision is made on a recommendation in answer to the clinical question based on the informed judgement of the Guidelines Leadership Group.

  • Strength Indicator: Good practice statementGood practice statement

There is high certainty of an interventions net positive but no direct supporting evidence. It has clear actionability, necessity, justifiability, efficiency and explicit rationale but is not supported by a systematic search.

  • Strength Indicator: Research recommendationResearch recommendation

A gap in the evidence has been identified as a priority for future research.