Tannenbaum Cara, Clow Barbara, Haworth-Brockman Margaret, Voss Patrice
Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man.
CMAJ Open. 2017 Feb 10;5(1):E66-E73. doi: 10.9778/cmajo.20160051. eCollection 2017 Jan-Mar.
The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which this evidence is integrated into clinical practice guidelines remains unknown. We aimed to determine the proportion of Canadian clinical practice guidelines that integrate evidence on sex and gender considerations.
We searched the Canadian Medical Association's CPG Infobase, PubMed, all provincial/territorial websites and websites of professional organizations for English- and French-language Canadian clinical practice guidelines published between January 2013 and June 2015 on selected conditions identified as priorities by policy-makers and practitioners. Citations and text were searched electronically using keyword terms related to sex and gender. Three investigators independently analyzed and categorized the content of text-positive clinical practice guidelines based on clinical relevance for practitioners.
Of the 118 clinical practice guidelines that met the inclusion criteria, 79 (66.9%) were text-positive for sex and/or gender keywords; 8 (10%) of the 79 used the keywords only in relation to pregnancy. Of the remaining 71 guidelines, 25 (35%) contained sex-related diagnostic or management recommendations. An additional 5 (7%) contained recommendations for sex-specific laboratory reference values, 29 (41%) referred to differences in epidemiologic features or risk factors only, and 12 (17%) contained nonrelevant mentions of search keywords. Twenty-five (35%) of the text-positive guidelines used the terms "sex" and/or "gender" correctly.
Recommendations related to sex and gender are inconsistently reported in Canadian clinical practice guidelines. Guidelines such as the Sex and Gender Equity in Research guidelines may help inform the meaningful inclusion of sex and gender evidence in the development of clinical practice guidelines.
性别在健康状况诊断和管理中的重要性已得到充分确立，但该证据纳入临床实践指南的程度仍不明确。我们旨在确定纳入性别相关考量证据的加拿大临床实践指南的比例。
我们检索了加拿大医学协会的CPG Infobase、PubMed、所有省/地区网站以及专业组织的网站，以查找2013年1月至2015年6月期间发布的关于政策制定者和从业者确定为优先事项的特定疾病的英法双语加拿大临床实践指南。使用与性别相关的关键词对引文和文本进行电子检索。三名研究人员根据对从业者的临床相关性，独立分析并对文本阳性的临床实践指南内容进行分类。
在符合纳入标准的118份临床实践指南中，79份（66.9%）在文本中出现了与性别相关的关键词；79份中的8份（10%）仅在与妊娠相关的情况下使用了这些关键词。在其余71份指南中，25份（35%）包含与性别相关的诊断或管理建议。另外5份（7%）包含针对特定性别的实验室参考值建议，29份（41%）仅提及流行病学特征或危险因素的差异，12份（17%）包含对检索关键词的无关提及。25份（35%）文本阳性的指南正确使用了“性别”和/或“社会性别”一词。
加拿大临床实践指南中关于性别相关的建议报告不一致。诸如《研究中的性别平等指南》等指南可能有助于为在临床实践指南制定过程中有意义地纳入性别相关证据提供参考。
