Assessment of the scope and quality of clinical practice guidelines in lung cancer
Assessment of the scope and quality of clinical practice guidelines in lung cancer
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DOI：
10.1378/chest.123.1_suppl.7s
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发表时间：
2003-01-01
期刊：
影响因子：
9.6
通讯作者：
McCrory, DC
中科院分区：
文献类型：
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作者：
Harpole, LH;Kelley, MJ;McCrory, DC
研究目的：为了为美国胸科医师学会(ACCP)肺癌指南的制定提供循证背景，对已发表的肺癌指南进行了系统的文献综述，以确定已发表的肺癌指南并对其质量进行评估。设计、设置和对象：系统检索1989年1月至2001年7月发表的MEDLINE、Cancerlight、CINAHL、HealthStar、Cochrane图书馆和国家指南信息中心的相关文献。测量和结果：从369条引文中确定51条相关指南。每个指南都由至少四名评价者使用研究和评价指南评估(Agree)工具进行评估，并针对所涵盖的临床主题进行编码。每个准则中包含的建议也被提炼出来。在评估的51项指南中，27项(53%)是循证的。ACCP为他们的指南工作确定的临床主题每个都由至少一个现有的指南代表。在从指南中提取的880条临床建议中，只有253条(29%)是循证的。《协定》文书对六个领域的指导方针进行了评级。作为一个整体，这些指南在范围和目的领域表现良好，只有6个指南(12%)得分50%。然而，对于其余领域，指南的表现不佳，如下：对于利益相关者参与，41个指南(80%)得分50%；在开发的严谨性方面，29个准则(57%)得分50%；在清晰度和表达方面，17个准则(33%)得分50%；在适用性方面，46个准则(90%)得分50%；在编辑独立性方面，47个准则(92%)得分50%。在考虑了领域得分后，评价者只推荐了19个指南(37%)。结论：至少有一个指南涵盖了所有主要的临床肺癌主题，但没有一个指南涵盖所有领域。此外，尽管现有的指南可以准确地反映临床实践，但大多数指南在质量评估时表现不佳。今后处理商定文书每一项的准则工作将大大增加文献的内容。
Study objectives: To provide an evidence-based background for developing the American College of Chest Physicians (ACCP) lung cancer guidelines, a systematic review of the literature was performed to identify published lung cancer guidelines and evaluate their quality.Design, setting, and participants: A systematic search was performed for relevant literature from MEDLINE, Cancerlit, CINAHL, HealthStar, the Cochrane Library, and the National Guidelines Clearinghouse published from January 1989 to July 2001.Measurement and results: From 369 citations, 51 relevant guidelines were identified. Each guideline was evaluated by at least four reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and was coded for clinical topics covered. The recommendations included in each guideline also were abstracted. Of the 51 guidelines evaluated, 27 (53%) were evidence-based. Clinical topics identified by the ACCP for their guide-line effort each were represented by at least one existing guideline. Of the 880 clinical recommendations abstracted from the guidelines, only 253 (29%) were evidence-based. The AGREE instrument rates guidelines along six domains. As a group, the guidelines performed well in the scope and purpose domain, with only six guidelines (12%) scoring < 50%. For the remaining domains, however, the guidelines did not perform as well, as follows: for stakeholder involvement, 41 guidelines (80%) scored < 50%; for rigor of development, 29 guidelines (57%) scored < 50%; for clarity and presentation, 17 guidelines (33%) scored < 50%; for applicability, 46 guidelines (90%) scored < 50%; and for editorial independence, 47 guidelines (92%) scored < 50%. After considering the domain scores, the reviewers recommended only 19 of the guidelines (37%).Conclusions: All major clinical lung cancer topics are covered by at least one guideline, but no single guideline addresses all areas. Furthermore, although existing guidelines may accurately reflect clinical practice, most performed poorly when evaluated for quality. Future guideline efforts that address each item of the AGREE instrument would add substantially to the literature.