Write the recommendations

It is the role of your expert committee to decide what recommendations to make from the evidence. The guideline should clearly state how the committee moved from the evidence to reach each recommendation, as well as the quality of the evidence (such as its GRADE rating). There are some considerations to make at this stage:

• They should consider whether the benefits of an intervention outweigh its potential harms and cost/resource use. There could be a trade-off between economic considerations and resource use if economic investigations have been undertaken.
• The committee will need to consider the feasibility of putting certain recommendations in place and the change in practice that will need to occur by doing so.
• It may also be useful for the committee to consider potential facilitators and barriers to the guidelines application as outlined in Domain 5 of the AGREE II Checklist. 

Wording the recommendations

Recommendations must be concise, unambiguous and easy to translate into practice by the intended audience. Each recommendation should include only one main action, though there can be bullet points underneath it which can contain more action points.

According to NICE, the wording of recommendations should be agreed by the Committee and should:

• Focus on the specific action that needs to be taken, and where appropriate, who needs to take this action
• Detail the intended population, the setting and, where relevant, the time frame for the intervention
• Reflect the strength of the recommendation, based on the quality of evidence
• Emphasise the involvement of people using services, carers where appropriate, and the public in making decisions
• Be ‘person-centred’
• Use clear English and avoid vague language and jargon

If the guideline is to be NICE approved, they must also:

• Use language and terms that NICE has agreed to ensure consistency across guidelines and other products
• Follow NICE’s standard advice on recommendations about medicines.

To find out more about each of these points, head to the NICE website.

In the AGREE II checklist under Domain 4 there are also recommendations regarding formatting here

Identifying opportunities for shared decision making

Guidelines should include information to support shared decision-making between people and healthcare professionals. This is particularly important at ‘preference-sensitive decision points’, such as when there are two or more effective options for treatment/care that deliver similar outcomes.

The guidelines should give healthcare providers and patients the information they need to make an informed decision. This includes weighing up the efficacy/effectiveness, safety, practical factors and quality of evidence for each option.

Formulating research recommendations

Your committee is likely to identify areas in which there are uncertainties or in which robust evidence is lacking. From these uncertainties, the committee should select some key areas to suggest as future research topics.

Find out more about this process in NICE’s Research recommendations process and methods guide.