Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Commentary

New grades for recommendations from the Canadian Task Force on Preventive Health Care

; Canadian Task Force on Preventive Health Care
CMAJ August 05, 2003 169 (3) 207-208;
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

To assist physicians and other users of the work of the Canadian Task Force on Preventive Health Care, our recommendations for clinical preventive actions are now organized into 6 letter grades or categories based on synthesis and evaluation of the best available evidence. We have recently made several refinements that we hope will be helpful to those who use our work. The changes reflect the ongoing evolution of methodology and reporting, both within our group and in the larger context of evidence-based medicine.1,2,3

In our original scheme,4 the “C” category reflected an evidence base that precluded a clear recommendation for action. The was because, taken together, the existing evidence was either conflicting or inconclusive, even though it was of adequate quantity and quality, or because the evidence was lacking in quantity or quality. Given the growing volume of evidence in general and the corresponding number of “C” grades, we felt there was value in distinguishing between these 2 situations.

Our new addition is the “I” grade. It lets clinicians, the public and policy-makers know that the existing body of evidence is of insufficient quantity or quality (or both) to support a specific recommendation for that clinical preventive action. Because there is, in effect, no supporting research evidence, a decision to provide the clinical preventive action thus must be based on something other than evidence.

Our new “C” grade is now reserved for cases where evidence of adequate quantity and quality may exist, but it is conflicting in that the effectiveness of the action remains unclear; i.e., different studies are of adequate quality but have different results, or the balance of benefits and harms in the body of available evidence is equivocal. Frustrating as this can be for clinicians and their patients, the “C” grade signals a situation where other factors, such as values and individual patient characteristics, may play an even larger role than when evidence is clear-cut. That is, because there is some evidence that could be considered in light of the patient's specific context, a more detailed discussion between the physician and patient may be required.

Finally, we have changed some of the language used to describe each grade. We now focus on whether the evidence supports a recommendation for or against a specific clinical preventive action rather than whether it should be included or excluded in the periodic health examination. This new approach speaks specifically to the clinical preventive action rather than anchoring the recommendations to a particular organizing framework for preventive care.

An overarching new emphasis, reflected in the footnote to Table 1, is the importance of communication between the patient and provider regarding evidence for the effectiveness of an action, including its potential risks and benefits, and the broader contextual and value-specific factors that are part of the decision-making context. Evidence is only one facet of a more complex and individualized process, but we continue to believe that knowing what works and what does not is an essential component of decision-making.

View this table:
  • View inline
  • View popup
  • Download powerpoint

Table 1.

We hope that these revisions, along with our new clinically oriented brief “recommendation statements,”5,6,7,8,9,10 will provide greater clarity to clinicians and their patients and strengthen the base on which rational preventive care is provided.

𝛃 See related article page 213

Footnotes

  • Competing interests: None declared.

References

  1. 1.↵
    Mulrow CD, Cook D, editors. Systematic reviews: synthesis of best evidence for health care decisions. Philadelphia: American College of Physicians; 1998.
  2. 2.↵
    Cook D, Giacomini M. The trials and tribulations of clinical practice guidelines. JAMA 1999;281:1950-1.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(3 Suppl):21-35.
    OpenUrlPubMed
  4. 4.↵
    Woolf SH, Battista RN, Anderson GM, Logan AG, Wang E. Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. A report by the Canadian Task Force on the Periodic Health Examination. J Clin Epidemiol 1990;43:891-905.
    OpenUrlCrossRefPubMed
  5. 5.↵
    Feightner JW. Changing course in electronic seas: rapid publication of brief recommendation statements by the Canadian Task Force on Preventive Health Care. CMAJ 2001;164:1856.
    OpenUrlFREE Full Text
  6. 6.↵
    Varicella vaccination: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2001;164(13):1888-9.
    OpenUrlFREE Full Text
  7. 7.↵
    Colorectal cancer screening: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2001;165(2):206-8.
    OpenUrlFREE Full Text
  8. 8.↵
    Screening for otitis media with effusion: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2001;165(8):1092-3.
    OpenUrlFREE Full Text
  9. 9.↵
    Prevention of group B streptococcal infection in newborns: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2002;166(7):928-30.
    OpenUrlFREE Full Text
  10. 10.↵
    Use of back belts to prevent occupational low-back pain: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2003;169(3):213-4.
    OpenUrlFREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 169 (3)
CMAJ
Vol. 169, Issue 3
5 Aug 2003
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
New grades for recommendations from the Canadian Task Force on Preventive Health Care
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
New grades for recommendations from the Canadian Task Force on Preventive Health Care
CMAJ Aug 2003, 169 (3) 207-208;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
New grades for recommendations from the Canadian Task Force on Preventive Health Care
CMAJ Aug 2003, 169 (3) 207-208;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • Use of back belts to prevent occupational low-back pain
  • PubMed
  • Google Scholar

Cited By...

  • Practice guideline: joint CCMG-SOGC recommendations for the use of chromosomal microarray analysis for prenatal diagnosis and assessment of fetal loss in Canada
  • Releve postnatal Rourke 2014: Outil fonde sur des donnees probantes pour la sante des nourrissons et des enfants de la naissance jusqu'a 5 ans
  • Rourke Baby Record 2014: Evidence-based tool for the health of infants and children from birth to age 5
  • The management of opioid dependence during pregnancy in rural and remote settings
  • La fin du jeune?: Mise a jour sur la preparation des patients pour une analyse du cholesterol
  • Break the fast?: Update on patient preparation for cholesterol testing
  • Nouvelle approche a la prise en charge des condylomes
  • New approach to managing genital warts
  • AIUM Practice Guideline for the Performance of Obstetric Ultrasound Examinations
  • Getting it right from birth to kindergarten: What's new in the Rourke Baby Record?
  • Les bons conseils de la naissance a la maternelle: Quoi de neuf dans le Releve postnatal Rourke?
  • Early Childhood Caries in Indigenous Communities
  • Management of Papanicolaou test results that lack endocervical cells
  • Congenital varicella syndrome: the evidence for secondary prevention with varicella-zoster immune globulin
  • Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline
  • Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary)
  • Update on well-baby and well-child care from 0 to 5 years: What's new in the Rourke Baby Record?
  • Achieving control of asthma in preschoolers
  • Management of acute asthma in adults in the emergency department: assisted ventilation
  • Management of acute asthma in adults in the emergency department: nonventilatory management
  • Assessment of Fever in African Children: Implication for Malaria Trials
  • Asthma that is unresponsive to usual care
  • Management of asthma in adults
  • Diagnosis of asthma in adults
  • Influenza vaccine for all?
  • Screening for depression in primary care: recommendation statement from the Canadian Task Force on Preventive Health Care
  • Google Scholar

More in this TOC Section

  • Ensuring timely genetic diagnosis in adults
  • The case for improving the detection and treatment of obstructive sleep apnea following stroke
  • Laser devices for vaginal rejuvenation: effectiveness, regulation and marketing
Show more Commentary

Similar Articles

Collections

  • Article Types
    • Guidelines

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire