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J Clin Epidemiol. 2012 Mar;65(3):268-75. doi: 10.1016/j.jclinepi.2011.08.001. Epub 2011 Nov 9.

"Might" or "suggest"? No wording approach was clearly superior in conveying the strength of recommendation.

Author information

1
Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA. elieakl@buffalo.edu

Abstract

OBJECTIVE:

To compare different wording approaches for conveying the strength of health care recommendations.

STUDY DESIGN AND SETTING:

Participants were medical residents in Canada and the United States. We randomized them to one of three wording approaches, each expressing two strengths of recommendation, strong and weak: (1) "we recommend," "we suggest;" (2) "clinicians should," "clinicians might;" (3) "we recommend," "we conditionally recommend." Each participant received one strong and one weak recommendation. For each recommendation, they chose a hypothetical course of action; we judged whether their choice was appropriate for the strength of the recommendation.

RESULTS:

The response rate was 77% (341/441). Most participants, in response to strong recommendations, chose hypothetical courses of action appropriate for weak recommendations. None of the wording approaches was clearly superior in conveying the strength of a recommendation. However, different approaches appeared superior depending on the strength and direction (for or against an intervention) of the recommendation.

CONCLUSION:

No wording approach was clearly superior in conveying the strength of recommendation. Guideline developers need to make the connection between the wording and their intended strength explicit.

PMID:
22075112
DOI:
10.1016/j.jclinepi.2011.08.001
[Indexed for MEDLINE]
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