An interpretation and commentary on the classification and framework of actionable statements in clinical practice guidelines_Chinese Journal of Evidence-Based Medicine

Authors：

Paerwenayi Talifu , ZHU Shuqiong , RUAN Siyuan , WANG Yongbo , YAN Siyu , HUANG Qiao , JIN Yinghui ,  REN Xiangying

Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, P. R. China;

Corresponding?author：

REN Xiangying, Email: renxy199797@163.com

Keywords：

Clinical practice guidelines; Guideline statements; Actionable statements; Recommendations; Classification framework; Interpretation

DOI：

10.7507/1672-2531.202511021

Video：

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Clinical practice guidelines serve as a critical tool for bridging evidence and clinical practice, with the quality and clarity of their recommendations directly influencing implementation outcomes. Based on the classification framework of guideline actionable statements proposed by Lotfi, this article systematically interprets the definitions, characteristics, and applicable conditions of six types of guideline statements: formal recommendations, research only recommendations, good practice statements, implementation considerations, tools and tips, remarks, and informal recommendations. A comparative analysis with mainstream international guideline development manuals is also provided. The article emphasizes the importance of standardizing statement classification to enhance the methodological quality and implement ability of guidelines, offering practical insights for both guideline developers and users.

Citation： Paerwenayi Talifu, ZHU Shuqiong, RUAN Siyuan, WANG Yongbo, YAN Siyu, HUANG Qiao, JIN Yinghui, REN Xiangying. An interpretation and commentary on the classification and framework of actionable statements in clinical practice guidelines. Chinese Journal of Evidence-Based Medicine, 2026, 26(5): 559-564. doi: 10.7507/1672-2531.202511021 Copy

1.	Graham R, Mancher M, Wolman DM. Clinical practice guidelines we can trust. Washington: National Academies Press, 2011.
2.	Norris SL. GRADE good practice statements: a time to say "good-bye". A new typology for normative statements on interventions. J Clin Epidemiol, 2024, 171: 111371.
3.	史乾靈, 劉輝, 王子君, 等. 正確理解和應用低質量證據形成指南推薦意見. 協和醫學雜志, 2024, 15(3): 676-685.
4.	靳英輝, 黃瑞秀, 靳永萍, 等. 臨床實踐指南制訂方法—指南推薦意見的撰寫及呈現. 中國循證心血管醫學雜志, 2018, 10(8): 897-902.
5.	Dumonceau JM, Hassan C, Riphaus A, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline development policy. Endoscopy, 2012, 44(6): 626-629.
6.	Rosenfeld RM, Shiffman RN, Robertson P, et al. Clinical practice guideline development manual, third edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg, 2013, 148(1 Suppl): S1-S55.
7.	Gooi Z. Why actionable statements are needed for measurement development. Otolaryngol Head Neck Surg, 2018, 158(3): 407-408.
8.	Scottish Intercollegiate Guidelines Network. A guideline developer’s handbook. 2019.
9.	Guyatt GH, Alonso-Coello P, Schünemann HJ, et al. Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group. J Clin Epidemiol, 2016, 80: 3-7.
10.	Lotfi T, Hajizadeh A, Moja L, et al. A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations. J Clin Epidemiol, 2022, 141: 161-171.
11.	World Health Organization. WHO guidelines on tuberculosis infection prevention and control: 2019 update. 2019.
12.	Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19 (September 2022). Clin Infect Dis, 2024, 78(7): e250-e349.
13.	Zheng XL, Vesely SK, Cataland SR, et al. Good practice statements (GPS) for the clinical care of patients with thrombotic thrombocytopenic purpura. J Thromb Haemost, 2020, 18(10): 2503-2512.
14.	Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv, 2018, 2(22): 3257-3291.
15.	World Health Organization. Guidelines for surveillance of drug resistance in tuberculosis (5th edition). 2015.
16.	GRADE Working Group. GRADE handbook. 2013.
17.	World Health Organization. WHO handbook for guideline development: 2nd edition. 2014.
18.	National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. 2014.
19.	National Health and Medical Research Council. Guidelines for guidelines: adopting, adapting and developing guidelines, Version 2.1. 2023.
20.	Ren X, Lotfi T, Chen J, et al. Identifying actionable statements in Chinese health guidelines: a cross-sectional study. BMJ Evid Based Med, 2025, 30(5): 305-312.
21.	丁楠, 袁靜云, 趙楠琦, 等. 針灸臨床實踐指南推薦意見框架的研究. 中華中醫藥雜志, 2022, 37(11): 6352-6357.
22.	羅旭飛, 呂晗, 宋再偉, 等. 生成式人工智能對臨床實踐指南制訂、評價和應用的影響. 協和醫學雜志, 2024, 15(5): 1173-1181.
23.	Boyle A, Huo B, Sylla P, et al. Large language model-generated clinical practice guideline for appendicitis. Surg Endosc, 2025, 39(6): 3539-3551.
24.	Ruan M, Fan J, Liu M, et al. Artificial intelligence for the science of evidence synthesis: how good are AI-powered tools for automatic literature screening. BMC Med Res Methodol, 2025, 25(1): 199.
25.	Kresevic S, Giuffrè M, Ajcevic M, et al. Optimization of hepatological clinical guidelines interpretation by large language models: a retrieval augmented generation-based framework. NPJ Digit Med, 2024, 7(1): 102.
26.	Luo X, Chen F, Zhu D, et al. Potential roles of large language models in the production of systematic reviews and meta-analyses. J Med Internet Res, 2024, 26: e56780.
27.	Konet A, Thomas I, Gartlehner G, et al. Performance of two large language models for data extraction in evidence synthesis. Res Synth Methods, 2024, 15(5): 818-824.

1. Graham R, Mancher M, Wolman DM. Clinical practice guidelines we can trust. Washington: National Academies Press, 2011.
2. Norris SL. GRADE good practice statements: a time to say "good-bye". A new typology for normative statements on interventions. J Clin Epidemiol, 2024, 171: 111371.
3. 史乾靈, 劉輝, 王子君, 等. 正確理解和應用低質量證據形成指南推薦意見. 協和醫學雜志, 2024, 15(3): 676-685.
4. 靳英輝, 黃瑞秀, 靳永萍, 等. 臨床實踐指南制訂方法—指南推薦意見的撰寫及呈現. 中國循證心血管醫學雜志, 2018, 10(8): 897-902.
5. Dumonceau JM, Hassan C, Riphaus A, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline development policy. Endoscopy, 2012, 44(6): 626-629.
6. Rosenfeld RM, Shiffman RN, Robertson P, et al. Clinical practice guideline development manual, third edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg, 2013, 148(1 Suppl): S1-S55.
7. Gooi Z. Why actionable statements are needed for measurement development. Otolaryngol Head Neck Surg, 2018, 158(3): 407-408.
8. Scottish Intercollegiate Guidelines Network. A guideline developer’s handbook. 2019.
9. Guyatt GH, Alonso-Coello P, Schünemann HJ, et al. Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group. J Clin Epidemiol, 2016, 80: 3-7.
10. Lotfi T, Hajizadeh A, Moja L, et al. A taxonomy and framework for identifying and developing actionable statements in guidelines suggests avoiding informal recommendations. J Clin Epidemiol, 2022, 141: 161-171.
11. World Health Organization. WHO guidelines on tuberculosis infection prevention and control: 2019 update. 2019.
12. Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19 (September 2022). Clin Infect Dis, 2024, 78(7): e250-e349.
13. Zheng XL, Vesely SK, Cataland SR, et al. Good practice statements (GPS) for the clinical care of patients with thrombotic thrombocytopenic purpura. J Thromb Haemost, 2020, 18(10): 2503-2512.
14. Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv, 2018, 2(22): 3257-3291.
15. World Health Organization. Guidelines for surveillance of drug resistance in tuberculosis (5th edition). 2015.
16. GRADE Working Group. GRADE handbook. 2013.
17. World Health Organization. WHO handbook for guideline development: 2nd edition. 2014.
18. National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. 2014.
19. National Health and Medical Research Council. Guidelines for guidelines: adopting, adapting and developing guidelines, Version 2.1. 2023.
20. Ren X, Lotfi T, Chen J, et al. Identifying actionable statements in Chinese health guidelines: a cross-sectional study. BMJ Evid Based Med, 2025, 30(5): 305-312.
21. 丁楠, 袁靜云, 趙楠琦, 等. 針灸臨床實踐指南推薦意見框架的研究. 中華中醫藥雜志, 2022, 37(11): 6352-6357.
22. 羅旭飛, 呂晗, 宋再偉, 等. 生成式人工智能對臨床實踐指南制訂、評價和應用的影響. 協和醫學雜志, 2024, 15(5): 1173-1181.
23. Boyle A, Huo B, Sylla P, et al. Large language model-generated clinical practice guideline for appendicitis. Surg Endosc, 2025, 39(6): 3539-3551.
24. Ruan M, Fan J, Liu M, et al. Artificial intelligence for the science of evidence synthesis: how good are AI-powered tools for automatic literature screening. BMC Med Res Methodol, 2025, 25(1): 199.
25. Kresevic S, Giuffrè M, Ajcevic M, et al. Optimization of hepatological clinical guidelines interpretation by large language models: a retrieval augmented generation-based framework. NPJ Digit Med, 2024, 7(1): 102.
26. Luo X, Chen F, Zhu D, et al. Potential roles of large language models in the production of systematic reviews and meta-analyses. J Med Internet Res, 2024, 26: e56780.
27. Konet A, Thomas I, Gartlehner G, et al. Performance of two large language models for data extraction in evidence synthesis. Res Synth Methods, 2024, 15(5): 818-824.

Chinese Journal of Evidence-Based Medicine

An interpretation and commentary on the classification and framework of actionable statements in clinical practice guidelines

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