Which grade indicates small or uncertain benefits and should be individualized?

• A. A
• B. B
• C. C
• D. D

Answer: (C)

This grade reflects situations where the net benefit of a screening, test, or preventive service is small or uncertain, and decisions should be tailored to the individual patient. When the evidence does not show a clear, substantial benefit for most people, clinicians are encouraged to discuss potential gains and harms with the patient, consider the patient’s values, risk factors, and preferences, and decide together whether to proceed. It sits between strong, routine recommendations and not recommending the service at all, signaling that there isn’t a one-size-fits-all answer.

In practice, this means you wouldn’t offer the service to everyone. You would explain that the benefit is uncertain or small, outline possible harms or downsides, and help the patient weigh whether the potential benefit aligns with their priorities. If a patient places high importance on a potential benefit or has specific risk factors that might tilt the balance, they may choose to proceed; if not, they may opt out.