What does a 'C' grade indicate?

• A. Large net benefit; strongly recommended.
• B. No net benefit; not recommended.
• C. Small net benefit; offered after individualized decision-making.
• D. Insufficient evidence to judge.

Answer: (C)

A C grade signals a small net benefit from the service, and because the benefit is modest and there may be harms or burdens, it should not be offered to everyone by default. Instead, it should be considered through individualized decision-making, meaning a clinician discusses the potential benefits and downsides with the patient, weighs the patient’s specific risk factors, and takes the patient’s values and preferences into account. If the patient values the possible benefit and accepts the uncertainties and possible harms, the service may be offered; if not, it may be deferred or declined. This sits between strong endorsements for large benefits and categorical refusals or insufficient evidence—where a blanket recommendation isn’t appropriate but a universal approach isn’t justified either.