Quality of Cancer Surveillance Clinical Practice Guidelines: Specificity and Consistency of Recommendations.
Quality of Cancer Surveillance Clinical Practice Guidelines: Specificity and Consistency of Recommendations.
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DOI：
10.1001/jamainternmed.2017.0079
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发表时间：
2017-05-01
影响因子：
39
通讯作者：
Baxi SS
中科院分区：
文献类型：
--
作者：
Merkow RP;Korenstein D;Yeahia R;Bach PB;Baxi SS
初级保健提供者 (PCP) 越来越负责照顾不断增长的癌症幸存者群体，但他们可能不熟悉针对该人群的适当癌症监测策略。临床实践指南可以为癌症随访护理和监测测试提供信息。模糊的建议和指南之间的不一致可能导致医疗资源的过度使用和不足，并对幸存者护理的成本和质量产生负面影响。检查癌症指南中积极治疗后监测建议的特异性和一致性。对 2010 年以来北美和欧洲发布的国家癌症指南的回顾性横断面分析，涉及九种最常见癌症幸存者的治疗后护理。我们将监测方式分为病史和体格检查、肿瘤标志物、诊断程序（例如结肠镜检查）和影像学。在每个指南中，我们将各个建议分为五类：1）基于风险的建议，2）建议，3）已解决但没有明确的建议，4）建议反对，或5）未解决。我们审查了每项监测建议的频率和停止日期，评估了指南之间的一致性，并分析了提出指南和建议特征的组织之间的关联。癌症监测指南建议的描述。我们确定了 2010 年 1 月 1 日至 2016 年 3 月 1 日期间发布的 40 条指南。其中 85% 来自专业组织。 85% 的指南中存在不明确的建议（即未讨论或没有明确建议的情况下讨论的方式），45% 的指南建议针对至少一项测试。欧洲指南比北美指南更有可能包含不明确的建议（72% vs. 100%，p<0.01）。建议通常会指定测试频率（从病史和体检的 89% 到手术/影像检查的 92%），但很少提供明确的停止时间。每种癌症的横截面成像建议因指南而异。例如，在乳腺癌指南中，有 2 个指南建议反对监测 CT 扫描，有 1 个指南在没有明确建议的情况下进行了讨论，有 3 个指南没有提及。针对癌症幸存者护理的指南特异性和一致性较低。随着指南的不断修订，开发人员应使用简单、明确、明确的语言来澄清支持或反对使用特定测试来优化护理质量和资源利用率的建议。
Primary care providers (PCP's), who are increasingly responsible for caring for the growing population of cancer survivors, may be unfamiliar with appropriate cancer surveillance strategies in this population. Clinical practice guidelines can inform cancer follow-up care and surveillance testing. Vague recommendations and inconsistencies among guidelines can lead to overuse and underuse of healthcare resources and negatively impact cost and quality of survivorship care. To examine the specificity and consistency of recommendations for surveillance after active treatment across cancer guidelines. Retrospective cross-sectional analysis of national cancer guidelines from North America and Europe published since 2010 addressing post-treatment care for survivors of the nine most common cancers. We categorized surveillance modalities into history and physical exams, tumor markers, diagnostic procedures (e.g., colonoscopy) and imaging. Within each guideline, we classified individual recommendations into five categories: 1) risk-based recommendation, 2) recommendation for, 3) addressed but no clear recommendation, 4) recommendation against, or 5) not addressed. We reviewed each surveillance recommendation for frequency and stop date, evaluated consistency among guidelines, and analyzed associations between the organizations proposing the guidelines and recommendation characteristics. Description of guideline recommendations for cancer surveillance. We identified 40 guidelines published between January 1st, 2010 and March 1st, 2016. Eighty-five percent were from professional organizations. Ambiguous recommendations (i.e., modality not discussed or discussed without a clear recommendation) were present in 85% of guidelines, and 45% recommended against at least one test. European guidelines were more likely than North American guidelines to contain ambiguous recommendations (72% vs. 100%, p<0.01). Recommendations commonly specified testing frequency (from 89% for history and physical exams to 92% for procedures/imaging) but infrequently provided a definitive stop time. Cross-sectional imaging recommendations varied among guidelines for each cancer. For example, among breast cancer guidelines, surveillance CT scans were recommended against in 2, discussed without a clear recommendation in 1, and not addressed in 3 guidelines. Guidelines addressing the care of cancer survivors have low specificity and consistency. As guidelines continue to be revised, developers should clarify recommendations with simple, non-ambiguous, definitive language for, or against, the use of specific tests to optimize care quality and resource utilization.
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影响因子：
6.2
作者：
Abdelsattar, Zaid M.;Reames, Bradley N.;Regenbogen, Scott E.;Hendren, Samantha;Wong, Sandra L.
通讯作者：
Wong, Sandra L.
医疗保健实践指南的报告工具：正确的声明
影响因子：
39.2
作者：
Chen, Yaolong;Yang, Kehu;Norris, Susan L.
通讯作者：
Norris, Susan L.
影响因子：
45.3
作者：
Gilligan, Timothy D.;Seidenfeld, Jerome;Hayes, Daniel F.
通讯作者：
Hayes, Daniel F.
影响因子：
3.2
作者：
Edwards, Frederick D.;Grover, Michael L.;Chang, Yu-Hui H.
通讯作者：
Chang, Yu-Hui H.
影响因子：
6.6
作者：
Haugen, Bryan R.;Alexander, Erik K.;Wartofsky, Leonard
通讯作者：
Wartofsky, Leonard