Department of Urology, Antonius Hospital, Utrecht, The Netherlands.
Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
World J Urol. 2018 Sep;36(9):1489-1494. doi: 10.1007/s00345-018-2278-7. Epub 2018 Apr 2.
Guidelines and recommendations become increasingly important in clinical urologic practice. This study aims to inform clinicians using guidelines on how to evaluate the quality of the methodology and transparency of these documents.
The guidelines on management of castration-resistant prostate cancer of the American Urology Association, European Association of Urology, National Comprehensive Cancer Network, National Institute for Health and Care Excellence, European Society of Medical Oncology were reviewed using the AGREE-II tool (Appraisal of Guidelines for Research and Evaluation). We reported and compared the domain scores for the domains 1 scope and purpose, 2 stakeholder involvement, 3 rigor of development, 4 clarity of presentation, 5 applicability, and 6 editorial independence (100% indicates highest-best quality score).
The domains evaluated highest and with lowest variability were 'editorial independence' (92% {88-95%}) and 'clarity of presentation' (83% {72-90%}), while the domains with the lowest scores and most variability were 'stakeholder involvement' (56% {36-79%}) and 'applicability' (40% {30-63%}). Length and extent of detail of guidelines vary considerably, each with its own strengths and limitations and adapted to target users. Standard external review using AGREE criteria may be preferable. A formal search strategy was not performed. Findings may be outdated by guidelines' updates.
Clinicians using practice guidelines need to be aware of the different domains of methodology and transparency used to assess the quality of guidelines contents and recommendations. Urologists increasingly use guidelines for support in evidence-based recommendations in clinical practice. It is very important to know how to assess these documents. This study applies standard criteria to compare the design and background of different available guidelines on prostate cancer no longer responding to hormonal treatment.
指南和建议在临床泌尿科实践中变得越来越重要。本研究旨在为临床医生提供使用指南的信息，指导他们评估这些文件的方法学质量和透明度。
使用 AGREE-II 工具（评估研究和评价指南）对美国泌尿科协会、欧洲泌尿科协会、国家综合癌症网络、英国国家卫生与保健优化研究所、欧洲肿瘤内科学会关于去势抵抗性前列腺癌管理的指南进行了回顾。我们报告并比较了以下领域的评分：1 范围和目的，2 利益相关者参与，3 制定的严谨性，4 表述的清晰度，5 适用性，6 编辑独立性（100%表示最高质量评分）。
评价最高且变异性最小的领域是“编辑独立性”（92%[88-95%]）和“表述的清晰度”（83%[72-90%]），而评分最低且变异性最大的领域是“利益相关者参与”（56%[36-79%]）和“适用性”（40%[30-63%]）。指南的长度和详细程度差异很大，每个指南都有自己的优势和局限性，并针对目标用户进行了调整。使用 AGREE 标准进行标准的外部审查可能更为可取。未进行正式的检索策略。由于指南的更新，研究结果可能已经过时。
使用实践指南的临床医生需要了解用于评估指南内容和建议质量的不同方法学和透明度领域。泌尿科医生越来越多地在临床实践中使用指南来支持基于证据的推荐。了解如何评估这些文件非常重要。本研究应用标准标准来比较不同的前列腺癌指南的设计和背景，这些指南不再对激素治疗有反应。
