Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Pain Manag Nurs. 2022 Aug;23(4):411-417. doi: 10.1016/j.pmn.2022.02.010. Epub 2022 Mar 16.
Several clinical practice guidelines (CPGs), consensus statements, and recommendations currently exist for the diagnosis and management of breakthrough cancer pain (BTcP). These documents have considerable variability amongst them, and to date, their quality and methodologic rigor have not been appraised.
We aim to identify and perform a quality appraisal of CPGs for the diagnosis and management of BTcP using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.
A comprehensive literature search was performed in MEDLINE (via PubMed), EMBASE, and SCOPUS databases up until January 1, 2021. Four reviewers independently evaluated each guideline using the AGREE II instrument. Scaled domain scores were generated and the threshold used for satisfactory quality was >60%. Additionally, intraclass correlation coefficients (ICC) were calculated to determine level of agreement between reviewers.
Eleven guidelines were selected for final evaluation based on inclusion/exclusion criteria. Only one guideline was classified of "average" quality while the rest were classified as "low" quality. The "Editorial Independence" (70.46 ± 35.7) and "Scope and Purpose" (64.78 ± 12.5) domains received the highest mean scores, while the "Applicability" (32.58 ± 13.5) and "Rigor of Development" (35.04 ± 9.0) domains received the lowest mean scores. ICC statistical analysis showed high magnitude of agreement between reviewers with a range of (0.790-0.988).
Reflecting upon our quality appraisal, it is evident that the quality and methodologic rigor of BTcP guidelines can be improved upon in the future. Our findings also elucidate the existing variability/discrepancies among guidelines in diagnostic criteria and management of BTcP.
目前有几个临床实践指南（CPG）、共识声明和建议用于突破性癌症疼痛（BTcP）的诊断和管理。这些文件之间存在很大的差异，迄今为止，它们的质量和方法严谨性尚未得到评估。
我们旨在使用评估指南研究与评估（AGREE II）工具来确定和评估用于诊断和管理 BTcP 的 CPG，并评估其质量。
我们在 MEDLINE（通过 PubMed）、EMBASE 和 SCOPUS 数据库中进行了全面的文献检索，检索时间截至 2021 年 1 月 1 日。四名评审员使用 AGREE II 工具独立评估每个指南。生成了比例域评分，并使用>60%作为满意质量的阈值。此外，还计算了组内相关系数（ICC）以确定评审员之间的一致性水平。
根据纳入/排除标准，最终有 11 个指南被选中进行评估。只有一个指南被归类为“平均”质量，其余的都被归类为“低”质量。“编辑独立性”（70.46±35.7）和“范围和目的”（64.78±12.5）领域获得了最高的平均分数，而“适用性”（32.58±13.5）和“发展严谨性”（35.04±9.0）领域获得了最低的平均分数。ICC 统计分析显示，评审员之间存在高度的一致性，范围为（0.790-0.988）。
根据我们的质量评估，BTcP 指南的质量和方法严谨性在未来可以得到提高。我们的研究结果还阐明了在 BTcP 的诊断标准和管理方面，指南之间存在的差异和不一致性。
