What does an 'I' statement indicate?

• A. Net benefit is clearly positive.
• B. The level of confidence in net benefit is high.
• C. The service has no net benefit.
• D. Evidence is insufficient to assess net benefit; decision-making should be individualized.

Answer: (D)

An I rating means there isn’t enough high-quality evidence to determine whether the service provides a net benefit. It signals uncertainty in the balance of benefits and harms, often due to limited data, inconsistent results, or incomplete understanding of potential harms. Because the net benefit is uncertain, decisions should be tailored to the individual patient: discuss what is known and unknown, consider the patient’s values and preferences, and weigh potential benefits and harms in the specific clinical context. This is why the statement about insufficient evidence and individualized decision-making best captures the meaning of an I rating. The other ideas imply a definite benefit, a high level of certainty, or no net benefit, which do not fit an I designation.