Department of General Surgery, Breast cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain.
Hospital Público de Verín, Ourense, Spain.
Br J Cancer. 2023 Apr;128(6):946-957. doi: 10.1038/s41416-022-02070-4. Epub 2022 Dec 7.
High-quality clinical practice guidelines (CPGs) and consensus statements (CSs) are essential for evidence-based medicine. The purpose of this systematic review was to appraise the quality and reporting of colorectal cancer (CRC) screening CPGs and CSs. After prospective registration (Prospero no: CRD42021286156), a systematic review searched CRC guidances in duplicate without language restrictions in ten databases, 20 society websites, and grey literature from 2018 to 2021. We appraised quality with AGREE II (% of maximum score) and reporting with RIGHT (% of total 35 items) tools. Twenty-four CPGs and 5 CSs were analysed. The median overall quality and reporting were 54.0% (IQR 45.7-75.0) and 42.0% (IQR 31.4-68.6). The applicability had low quality (AGREE II score <50%) in 83% of guidances (24/29). Recommendations and conflict of interest were low-reported (RIGHT score <50%) in 62% guidances (18/29) and 69% (20/29). CPGs that deployed systematic reviews had better quality and reporting than CSs (AGREE: 68.5% vs. 35.5%; p = 0.001; RIGHT: 74.6% vs. 41.4%; p = 0.001). In summary, CRC screening CPGs and CSs achieved low quality and reporting. It is necessary a revision and an improvement of the current guidances. Their development should apply a robust methodology using proper guideline development tools to obtain high-quality evidence-based documents.
高质量的临床实践指南(CPG)和共识声明(CS)是循证医学的基础。本系统评价的目的是评估结直肠癌(CRC)筛查 CPG 和 CS 的质量和报告情况。在前瞻性注册(Prospero 编号:CRD42021286156)后,我们在 2018 年至 2021 年期间,在十个数据库、20 个协会网站和灰色文献中,对 CRC 指南进行了无语言限制的重复系统检索。我们使用 AGREE II(最高得分的百分比)和 RIGHT(35 个项目总分的百分比)工具评估质量和报告情况。分析了 24 项 CPG 和 5 项 CS。总体质量和报告的中位数分别为 54.0%(四分位距 45.7-75.0)和 42.0%(四分位距 31.4-68.6)。83%(24/29)的指南适用性质量较低(AGREE II 评分 <50%)。62%(18/29)和 69%(20/29)的指南中推荐意见和利益冲突报告不足(RIGHT 评分 <50%)。使用系统评价制定的 CPG 比 CS 的质量和报告更好(AGREE:68.5% vs. 35.5%;p=0.001;RIGHT:74.6% vs. 41.4%;p = 0.001)。总之,CRC 筛查 CPG 和 CS 的质量和报告都较低。有必要对当前的指南进行修订和改进。在制定这些指南时,应使用适当的指南制定工具,采用稳健的方法,以获得高质量的循证文件。