A new international methodological guideline from the GRADE group (Grading of Recommendations Assessment, Development, and Evaluation) has updated the criteria for developing and using so-called good practice statements in clinical practice and public health guidelines. The document, published as a special article in Annals of Internal Medicine, one of the most influential medical journals worldwide, seeks to avoid the inappropriate or excessive use of this type of statement and improve its justification, transparency, and credibility.
Researchers from the Clinical Epidemiology and Health Services Research Group at the Institut de Recerca Sant Pau (IR Sant Pau) participated in the development of this update, together with investigators from the Iberoamerican Cochrane Center, an institution affiliated with IR Sant Pau. Among the authors are Dr. Pablo Alonso, a researcher at IR Sant Pau, as well as Drs. David Rigau and Carlos Canelo from the Iberoamerican Cochrane Center.
Good practice statements are reserved for interventions considered so obvious, essential, or ethically unquestionable—such as basic safety measures or respect for fundamental ethical principles—that conducting a formal systematic review of the evidence is not considered appropriate. However, in practice, these statements have sometimes been used to formulate recommendations without an explicit evaluation of the available evidence.
“For years we have seen good practice statements included in some guidelines without sufficiently explicit justification,” explains Dr. Pablo Alonso. “This can create confusion and, in the long term, undermine confidence in the recommendations, even when they aim to reinforce good practices.”
According to the researcher, the main objective of this update is “to help guideline developers more clearly distinguish when a recommendation can truly be considered a good practice and when, instead, it should undergo a formal evaluation of the evidence.”
The new methodological guidance proposes a revised definition of good practice statements and classifies them into three main categories, according to their primary foundation: those based on ethical principles and human rights; those grounded in widely accepted essential practices or principles; and those supported by strong and well-established scientific evidence.
This classification makes it possible to better contextualize each statement and explicitly clarify the reasoning behind it. “The goal is not to restrict their use, but to use these statements only when they are truly justified and to clearly document why they are formulated,” Alonso notes. “In this way, guidelines gain methodological consistency, transparency, and credibility.”
In addition, the guidance explicitly incorporates consideration of key decision-making criteria, such as potential benefits and risks, practical consequences, values and preferences, and resource implications. “Introducing these criteria systematically helps ensure that decisions are not perceived as arbitrary, but rather as the result of a reflective and structured process,” adds Dr. Alonso.
The article includes step-by-step practical examples and presents a structured tool that helps guideline development teams determine when it is appropriate to formulate a good practice statement and how to report it clearly, transparently, and reproducibly.
“We wanted to provide concrete and applicable tools, not just theoretical principles,” emphasizes Dr. Alonso. “The intention is for guideline development teams to apply this guidance easily and consistently, regardless of the clinical or public health context.”
The work builds on the authors’ methodological experience within the framework of the European Commission Initiative on Colorectal Cancer (ECICC), a project aimed at improving the quality and harmonization of clinical guidelines in this field.
For Dr. Alonso, this update has direct relevance for practice: “Clinical guidelines have a very significant influence on decision-making. Ensuring that even recommendations considered ‘obvious’ are well justified is key to maintaining the trust of professionals, policymakers, and patients.”
This new guidance is particularly relevant for those who develop, adapt, or implement evidence-based guidelines—an activity that is central to the Cochrane community and to public health decision-making. Its application may help reduce the inappropriate use of good practice statements and strengthen the methodological quality and transparency of clinical recommendations.
Dewidar O, Akl EA, Morgano GP, Parmelli E, Saz-Parkinson Z, Langendam MW, Meerpohl JJ, Marti M, Mayer M, Djulbegovic B, Brignardello-Petersen R, Chu DK, Murad MH, Canelo-Aybar C, Mathew JL, Alonso-Coello P, Qaseem A, Schwingshackl L, Bognanni A, Rojas-Reyes MX, Morgan RL, Klugar M, Rigau Comas D, Stallings E, Iorio A, Tugwell P, Darzi A, Turgeon AF, Shamliyan TA, Munn Z, Mathioudakis AG, Piggott T, Lotfi T, Pottie K, Guyatt G, Schünemann HJ. GRADE guidance: Update on developing good practice statements in guidelines. Ann Intern Med 2026. https://doi.org/10.7326/ANNALS-25-00431.
Last update: 11 de March de 2026
