The role of the U.S. Preventive Services Task Force (USPSTF) is to provide "reliable and accurate evidence-based recommendations to primary care clinicians." Therefore, the USPSTF prefers to base its recommendations on interventional randomized, controlled trials (RCTs). But when the evidence is insufficient to make a recommendation-for example, RCTs aren't conducted on many clinical preventive services due to expense and recruitment issues-the USPSTF's lack of guidance can cause clinician frustration. In an effort to address clinician concerns, the USPSTF asked a group of experts to come up with a different approach to presenting recommendations when the "evidence is insufficient to conclude, with certainty, that there is net benefit or net harm."

The group suggested the creation of four "domains" to guide clinical decision making: potential preventable burden, potential harms, costs of the intervention, and a restating of current practice. Each domain considers the potential consequences (to patient, system, and clinician) of providing or not providing specific interventions.

The crux of the matter. Because RCTs aren't available on which to base decision making in all patient populations and conditions, we can expect to see the USPSTF use the four domains and their relevance to prevention strategies in its recommendations.