Canadian Smoking Cessation Clinical Practice Guideline

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CANADIAN SMOKING CESSATION GUIDELINEAPPENDIX F – Strength of Evidence Classification Tables for Clinical PracticeGuidelines Used as Evidence Base for CAN-ADAPTT’s Guideline DevelopmentThe following strength of evidence classification tables are for each of the existing CPGs used as the evidencebase for CAN-ADAPTT’s guideline development. Note that the grade of recommendation/strength of evidencetable for CAN-ADAPTT’s summary statements can be found in Appendix B.U.S. Department of Health and Human Services Public Health Service (2008)STRENGTH-OF-EVIDENCECLASSIFICATIONStrength of Evidence = AStrength of Evidence = BStrength of Evidence = CCRITERIAMultiple well-designed randomized clinical trials, directlyrelevant to the recommendation, yielded a consistentpattern of findings.Some evidence from randomized clinical trials supportedthe recommendation, but the scientific support was notoptimal. For instance, few randomized trials existed, thetrials that did exist were somewhat inconsistent, or thetrials were not directly relevant to the recommendation.Reserved for important clinical situations in which thePanel achieved consensus on the recommendation in theabsence of relevant randomized controlled trials.Registered Nurses Association of Ontario (RNAO) (2007)STRENGTH-OF-EVIDENCECLASSIFICATIONStrength of Evidence = AStrength of Evidence = BStrength of Evidence = CCRITERIARequires at least two randomized controlled trials as partof the body of literature of overall quality and consistencyaddressing the specific recommendations.Requires availability of well conducted clinical studies,but no randomized controlled trials on the topic ofrecommendations.Requires evidence from expert committee reports oropinions and/or clinical experience of respectedauthorities. Indicates absence of directly applicablestudies of good quality.APPENDICES 47
CANADIAN SMOKING CESSATION GUIDELINENew Zealand Ministry of Health (2007)GRADES OFRECOMMENDATIONSGrade of Recommendation = AGrade of Recommendation = BGrade of Recommendation = CGrade of Recommendation = IGrade of Recommendation =CRITERIAThe recommendation is supported by GOOD (strong)evidence.The recommendation is supported by FAIR (reasonable)evidence, but there may be minimal inconsistency oruncertainty.The recommendation is supported by EXPERT opinion(published) only.There is INSUFFICIENT evidence to make arecommendation.GOOD PRACTICE POINT (in the opinion of the guidelinedevelopment group).Institute for Clinical Systems Improvement (ICSI) (2004)EVIDENCE GRADING SYSTEMClasses of Research ReportsA. PRIMARY REPORTS OF NEW DATA COLLECTION:CLASS ACLASS BCLASS CCLASS DRandomized, controlled trialCohort studyNon-randomized trial with concurrent or historical controlsCase-control studyStudy of sensitivity and specificity of a diagnostic testPopulation-based descriptive studyCross-sectional studyCase seriesCase reportB. REPORTS THAT SYNTHESIZE OR REFLECT UPON COLLECTIONS OF PRIMARY REPORTS:CLASS MCLASS RCLASS XMeta-analysisSystematic reviewDecision analysisCost-effectiveness analysisConsensus statementConsensus reportNarrative reviewMedical opinionAPPENDICES 48
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Canadian Smoking Cessation Clinical Practice Guideline

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