Comparing the USPSTF and GRADE Approaches to Recommendations
- Diana B. Petitti, MD, MPH;
- Steven M. Teutsch, MD;
- Mary B. Barton, MD, MPP;
- George F. Sawaya, MD;
- Judith K. Ockene, PhD, Med; and
- Thomas DeWitt, MD
- From Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.
IN RESPONSE:
The USPSTF welcomes this opportunity to further explicate the similarities and differences between the GRADE and USPSTF approaches to making recommendations.
Guyatt and colleagues explain that guideline panels that use the GRADE approach may decide not to offer a recommendation and to provide clarifying statements. We agree that GRADE thus accommodates the situation in which the USPSTF uses an I statement. However, the USPSTF “rules of evidence” dictate that an I statement must always be issued if a letter grade of A, B, C, or D cannot be assigned (1, 2). This occurs when the USPSTF judges that the evidence about health benefits and harms does not permit at least moderate certainty that the balance of health benefits and harms is favorable, that no net benefit exists, or that the harms of the intervention outweigh the benefits (3). The values and preferences that individual patients place on benefits and harms are not considered by the USPSTF when deciding whether to assign a letter grade to a …
This 100-word excerpt has been provided in the absence of an abstract.
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