What does a 'C' grade mean?

• A. Benefits are small or uncertain; the decision to offer should be individualized.
• B. The service should be offered; benefits are large.
• C. The service should be offered only if patient preferences align.
• D. Insufficient evidence to assess benefits.

Answer: (A)

A mid-level grade signals that the net benefit of the service is small or uncertain, so there isn’t a universal push to offer it to everyone. Instead, the decision should be guided by shared decision-making: discuss the potential benefits and harms with the patient, weigh their individual risk factors and values, and tailor whether to offer the service based on that conversation. If a patient places high value on the possible benefit or has factors that increase potential benefit, offering it may be reasonable; if not, it may be reasonable to forego it. This nuance distinguishes it from strong recommendations to offer when benefits are large, or from insufficient evidence to assess benefits.