Clinical practice guidelines: potential misconceptions of the GRADE approach

Objective: To challenge the Grading of Recommendations Assessment, Development and Evaluation (GRADE) group to address the potential misconceptions about their approach to grading the strength of recommendations in clinical practice guidelines.

Study design and setting: Based on our own expertise of health care professionals trying to think in depth about, and using, guidelines, we have identified four such misconceptions.

Results: These potential misconceptions are: (1) evidence in medicine means factual or scientific evidence; (2) opinions are a subcategory of evidence; (3) the most important evidence is related to clinical benefits and harms; (4) being virtuous, and principled, does not particularly help in developing the best possible guidelines.

Conclusion: We call on the GRADE leadership to address all the above-mentioned misconceptions. These need explicit answers in their manuscript series.