有限的姑息治疗证据基础很难适应指南中使用的现有分级方案。许多建议都是基于专家共识或临床实践标准，这些标准通常被认为是“低质量”的证据。加强提供者在将建议转化为实践方面的犹豫不决对患者护理产生影响。合理选择适当的分级系统来评级证据，以支持姑息治疗临床实践指南中提出的建议。审查以英文出版的国际姑息治疗指南的方法部分确定了五个分级系统比较：建议分级、评估、制定和评价（GRADE）；苏格兰校际指南网络 (SIGN)；美国传染病学会-欧洲肿瘤内科学会 (IDSA-ESMO)；对定性研究审查 (CERQual) 和国家长期疾病服务框架 (NSF-LTC) 证据的信心。已发布的姑息治疗或末期症状管理指南中使用的分级系统之间存在异质性。 GRADE 因其方法严谨性以及与其他医学协会指南间的一致性而被越来越多地采用。 CERQual 有潜力支持由定性证据提供的建议，但其在临床指南中的作用尚不明确。 IDSA-ESMO 系统具有直观的类型学，能够对低质量证据进行分级。将常用的分级系统应用于姑息治疗证据库具有挑战性，因为姑息治疗证据库通常缺乏可靠的随机对照试验 (RCT)。 IDSA-ESMO 的采用为资源匮乏的指南制定者和姑息治疗临床医生提供了一种可行且实用的替代方案，而无需具备方法学专业知识。

The limited palliative care evidence base is poorly amenable to existing grading schemes utilized in guidelines. Many recommendations are based on expert consensus or clinical practice standards, which are often considered 'low-quality' evidence. Reinforcing provider hesitancy in translating recommendations to practice has implications for patient care.To rationalize the selection of an appropriate grading system for rating evidence to support recommendations made in palliative care clinical practice guidelines.Review of the methodology sections of international palliative care guidelines published in English identified five grading systems comparison: Grading of Recommendations, Assessment, Development and Evaluations (GRADE); the Scottish Intercollegiate Guidelines Network (SIGN); Infectious Diseases Society of America-European Society for Medical Oncology (IDSA-ESMO); Confidence in the Evidence from Reviews of Qualitative research (CERQual) and the National Service Framework for Long Term Conditions (NSF-LTC).There is heterogeneity among grading systems used in published palliative care or terminal symptom management guidelines. GRADE has been increasingly adopted for its methodological rigour and inter-guideline consistency with other medical associations. CERQual has the potential to support recommendations informed by qualitative evidence, but its role in clinical guidelines is less defined. The IDSA-ESMO system has an intuitive typology with the ability to categorize tiers of lower-quality evidence.It is challenging to apply commonly used grading systems to the palliative care evidence base, which often lacks robust randomized controlled trials (RCTs). Adoption of IDSA-ESMO offers a feasible and practical alternative for lower-resourced guideline developers and palliative clinicians without a prerequisite for methodological expertise.