The key to wording used in this guideline

The recommendations made in this guideline have been systematically graded, according to the quality of information available, to indicate the level of evidence on which recommendations are based. There are two strengths of recommendation made in this guideline, informed by the balance between desirable and undesirable effects, the quality of the evidence-base, values and preferences, and resource allocation within the UK health community. Understanding the wording is important when deciding how to accommodate these recommendations in your clinical practice.

Strong recommendations

These begin with action verbs like 'advise', 'assess', 'conduct', 'measure', 'offer', 'plan', 'refer', 'review', 'start' and similar.

A strong recommendation applies where the clinician reasons that most patients ought to receive the intervention, or where adherence to the recommendation could be used as a performance or quality indicator and that deviation from this recommendation would prompt documentation of a clinician's rationale for doing so.

Conditional recommendations

These begin with the term 'consider'

A conditional recommendation applies where the clinician examines the evidence within the wider health and social context and discusses the choices with the patient, taking into account the patient's values and preferences, or where documentation of the discussion of the pros and cons of an intervention is the indicator of quality, rather than the course of action itself.

Further information is provided in Appendix 3 and 4.