Evidence-based urology: understanding GRADE methodology

Grading of Recommendations Assessment, Development, and Evaluation (GRADE) is a methodologically rigorous and transparent framework for grading the certainty of evidence and moving from evidence to recommendations in guidelines. Certainty of evidence can be rated as high, moderate, low, or very low, and some domains may lead to an increase or decrease in the certainty of evidence. Once evidence is summarized, the certainty, balance of desirable and undesirable outcomes, patients' values and preferences, equity, acceptability, and feasibility are taken into consideration in order to give a strong or weak recommendation for or against an intervention. In this review we summarize the GRADE approach using urology-related examples. Patient summary: GRADE is a well-established system for determining how much confidence we can place in research evidence and how guideline panels can make recommendations for patient care and health care policy. Recommendations can be strong or weak for or against a treatment strategy. Guideline developers should consider the certainty of the evidence, the balance of desirable and undesirable outcomes, patients' values and preferences, and resource use. Published by Elsevier B.V. on behalf of European Association of Urology.

Automated summary

GRADE is a rigorous and transparent framework for grading the certainty of evidence and making recommendations. Recommendations can be strong or weak for or against an intervention, based on factors like evidence certainty, desirable and undesirable outcomes, patient values, and resource use. This approach is essential for guideline development in healthcare.