Wording of a recommendation should offer clinicians as many indicators as possible for understanding and interpreting the strength of recommendations:
- For strong recommendations, the GRADE working group has suggested adopting terminology, such as "we recommend..." or "clinicians should...".
- For weak recommendations, the GRADE working group has suggested less definitive wording, such as "we suggest..." or "clinicians might...".
Whatever terminology guideline panels use to communicate the dichotomous nature of a recommendation, it is essential that they inform their users what the terms imply. Guideline panels should describe patients or populations (characterized by the disease and other identifying factors) for whom the recommendation is intended and a recommended intervention as specifically and detailed as possible.
Wording strong and weak recommendations is particularly important when guidelines are developed by international organizations and/or are intended for patients and clinicians in different regions, cultures, traditions, and usage of language. It is also crucial to explicitly and precisely consider wording when translating recommendations into different languages.
It is important to adapt the wording of the recommendation to the available evidence. Absence of a statistically significant effect is no proof that an intervention does not work. It is only proven that an intervention doesn’t work if the confidence interval around the effect estimation excludes a minimally important difference or decision threshold.