Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain.
Hospital Público de Verín, Ourense, Spain.
Colorectal Dis. 2022 Dec;24(12):1472-1490. doi: 10.1111/codi.16270. Epub 2022 Aug 11.
Evidence-based medicine is essential for clinical practice. Clinical practice guidelines (CPGs) and consensus statements (CSs) ought to follow a consistent methodology to underpin high-quality healthcare. We systematically analysed the quality and reporting of colorectal (CRC) and anal cancer CPGs and CSs.
Embase, MEDLINE, Scopus, Web of Science, the Cochrane Database of Systematic Reviews and online sources (59 professional society websites and eight guideline databases) were systematically searched following prospective registration (PROSPERO no. CRD42021286146) by two reviewers independently, without language restrictions. CPGs and CSs about CRC and anal cancer treatment were included from January 2018 to November 2021 and were assessed using the AGREE II tool (per cent of maximum score) and the RIGHT tool (per cent of total 35 items) for quality and reporting respectively.
The median overall quality and reporting of the 59 guidelines analysed were 55.0% (interquartile range 47.0-62.0) and 58% (interquartile range 50.0-67.9), respectively, with a proportion scoring less than half (<50%) for quality (20/59, 33.9%) and reporting (15/59, 25.4%). Guidance reported that following AGREE II methodology scored better on average than that without (AGREE II 77.7% vs. 47.6%, P = 0.001; RIGHT 50.0% vs. 33.9%, P = 0.001). Guidelines based on systematic reviews had better quality and reporting on average than those based on consensus (AGREE II 56.5% vs. 46.6%, P = 0.001; RIGHT 36.9% vs. 35.4%, P = 0.019).
The quality and reporting of colorectal and anal cancer treatment CPGs and CSs were poor. Despite AGREE II and RIGHT inherent methodological limitations, few high-quality guidelines were found. Despite wide variability in scoring different domains, they merit urgent improvement in all areas. It has also been demonstrated that CPGs and CSs should be underpinned by systematic reviews collecting the best available clinical research findings.
循证医学对于临床实践至关重要。临床实践指南（CPG）和共识声明（CS）应该遵循一致的方法，以支持高质量的医疗保健。我们系统地分析了结直肠癌（CRC）和肛门癌 CPG 和 CS 的质量和报告。
两位审查员独立按照前瞻性注册（PROSPERO 编号 CRD42021286146），在 Embase、MEDLINE、Scopus、Web of Science、Cochrane 系统评价数据库和在线资源（59 个专业学会网站和 8 个指南数据库）中系统地搜索了 2018 年 1 月至 2021 年 11 月关于 CRC 和肛门癌治疗的 CPG 和 CS，不限制语言。使用 AGREE II 工具（最大得分的百分比）评估质量，RIGHT 工具（35 项总分的百分比）评估报告，分别对分析的 59 项指南进行评估。
分析的 59 项指南中，总体质量和报告中位数分别为 55.0%（四分位距 47.0-62.0）和 58%（四分位距 50.0-67.9），质量评分低于一半（<50%）的比例分别为 33.9%（20/59）和 25.4%（15/59）。报告遵循 AGREE II 方法的指南平均比不遵循的指南得分更高（AGREE II 77.7% vs. 47.6%，P=0.001；RIGHT 50.0% vs. 33.9%，P=0.001）。基于系统评价的指南平均比基于共识的指南质量和报告更好（AGREE II 56.5% vs. 46.6%，P=0.001；RIGHT 36.9% vs. 35.4%，P=0.019）。
结直肠癌和肛门癌治疗 CPG 和 CS 的质量和报告较差。尽管 AGREE II 和 RIGHT 存在固有方法学局限性，但发现的高质量指南很少。尽管在不同领域的评分存在很大差异，但所有领域都需要紧急改进。此外，还证明 CPG 和 CS 应该以系统评价为基础，系统评价收集最佳的现有临床研究结果。
