Evidence-based recommendations are constructed to aid decision-making, by combining the available evidence with clinical practice. However, when the evidence is low to very low, this often results in weak recommendations. In a medical situation, getting a straight answer is essential, so the questions arises – are these kind of weak recommendations actually useful?
A paper by Neumann et al 2018 investigated clinicians´preferences and what the course of action was, when they were provided with either solely evidence summaries or evidence summaries with a recommendation. Results showed that especially in the context of low/very low evidence, clinicians clearly prefered having recommendations in addition to evidence summaries. Furthermore, when recommendations where available, this led to a more appropriate course of action. The findings from Neumann were similar to Nasser et al., 2015. Here, the results revealed a high uptake of both strong and weak recommendations from WHO guidelines into national guidelines, showing that clinicians in general value both strong and weak recommendations.
As such, despite a recommendation being weak, it still provides answers. It gives you a direction on how to act, which is especially needed in a medical situation where there is uncertainty. Furthermore, it offers a hardcore fact-check on how much evidence is actually available for a given intervention, and how good this evidence is. As a clinician, you need to be aware of these flaws/missing evidence, in order to know how much emphasis you need to put on a given treatment. Last but not least, being aware of potential lack in evidence is essential to move a field forward. We need to know what is missing before we can improve.