Assessment

High certainty that the net benefit is substantial; offer or provide the service.

Grade B: high certainty of moderate net benefit, or moderate certainty of moderate-to-substantial net benefit; still offer or provide the service.

Selectively offer based on professional judgment and patient preferences; net benefit is small (moderate certainty).

Discourage use: moderate or high certainty of no net benefit or that harms outweigh benefits.

Current evidence is insufficient to assess the balance of benefits and harms; if offered, patients should understand the uncertainty.

Grades A and B.