1.3. Steps in the process

GRADE includes the following steps:

• Ask a specific healthcare question to be answered by a recommendation;
• Identify all important outcomes for this healthcare question;
• Judge the relative importance of outcomes;
• Summarize all relevant evidence;
• Grade the quality of evidence for each outcome and for each comparison;
• Decide on the overall quality of evidence across outcomes;
• Include judgments about the underlying values and preferences related to the management options and outcomes;
• Decide on the balance of desirable and undesirable effects;
• Decide on the balance of net benefits and cost;
• Grade the strength of recommendation;
• Formulate a recommendation;
• Implement and evaluate.

The steps are visualized in the following flowchart: