Fundamentally the GRADE approach is based on the philosophy of evidence based health care decision making, and involves the integration of three domains:
- 1. First, it considers the state of health and other circumstances such as where the decision making takes place. Are we dealing with a low income country, a high income country, a primary or tertiary care hospital? What are the circumstances and the health state that the individual patient presents with?
- 2. In the second domain, the patient’s, populations’ and societal values and preferences affect the importance of certain outcomes for decision making.
- 3. In the third domain, the actual underlying research evidence is carefully evaluated.