Djulbegovic B, Hadley T
Division of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
Oncology (Williston Park). 1998 Nov;12(11A):310-4.
The validity and applicability of recommendations in clinical medicine are dependent on the design of studies upon which recommendations are based. Large prospective randomized controlled trials (RCT) generally provide the most reliable data to help guide our treatment decisions. However, analysis of decision-making in the field of hematologic malignancies indicates that only 24% of decisions can be based on randomized controlled trials. This lack of high-quality data to support many decisions in the treatment of malignant disorders underscores the need to evaluate the evidence that forms the backbone of guidelines themselves. As physicians are encouraged to conform to clinical guidelines, it is important that information be made available regarding the quality of data upon which these guidelines are based. We propose the development and use of a guideline quality score based on the quality of evidence supporting each decision in a guideline. By linking the quality of evidence with specific recommendations, physicians will be in a better position to understand the strengths and weaknesses of practice guidelines. This linkage will also help physicians to streamline their efforts to obtain a new line of evidence when an existing one is not satisfactory.
临床医学中建议的有效性和适用性取决于这些建议所基于的研究设计。大型前瞻性随机对照试验（RCT）通常能提供最可靠的数据来帮助指导我们的治疗决策。然而，对血液系统恶性肿瘤领域决策制定的分析表明，只有24%的决策可以基于随机对照试验。在恶性疾病治疗中，缺乏高质量数据来支持许多决策，这凸显了评估构成指南核心的证据的必要性。由于鼓励医生遵循临床指南，提供这些指南所基于的数据质量信息就很重要。我们提议开发并使用一种基于支持指南中每个决策的证据质量的指南质量评分。通过将证据质量与具体建议联系起来，医生将能更好地理解实践指南的优缺点。这种联系还将帮助医生在现有证据不令人满意时，更高效地获取新的证据。
