Judge an outcome as patient-important when it reflects how patients feel, function, or survive, and record the reason for that classification so the judgement can be reviewed. GRADE rates certainty of evidence and strength of recommendations using explicit criteria and outcome-level judgements, so the importance call belongs to a specific outcome, not to the trial as a whole.
Classify the outcome
Ask what the measure captures for the patient. A winter-health example: hospital admission for respiratory illness or death reflects how patients fare; a laboratory antibody titre describes a biological marker. Record one line stating the outcome, the classification, and the reason, such as "hospital admission — patient-important — reflects a clinical event patients experience." Where an outcome sits between these poles, note the reasoning rather than leaving the cell blank.
Carry the classification into GRADE
GRADE's outcome-level judgements mean the importance classification travels with each outcome into the certainty rating and the summary-of-findings table. Write the implication next to the classification so a reader can see how it changes the rating: for example, whether a surrogate outcome lowers confidence in applying the result to patients, or whether a patient-important outcome anchors the recommendation.
Deliverable
Produce an outcome-importance note that lists each outcome, its classification, the recorded reason, and the effect on the GRADE rating. Cochrane Handbook Chapter 15 guidance on certainty and responsible review conclusions supports keeping that link explicit when you interpret results.
- List every outcome the trial reports and write the exact measure beside it.
- Classify each as patient-important or surrogate, and record the reason in one sentence.
- Note how that classification affects the GRADE certainty rating for that outcome.
- Review the note against the trial report so each classification traces to a stated measure.