Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations
Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations
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DOI：
10.1002/cncr.30047
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发表时间：
2016-07-15
期刊：
影响因子：
6.2
通讯作者：
Kremer, Leontien C. M.
中科院分区：
文献类型：
--
作者：
Font-Gonzalez, Anna;Mulder, Renee L.;Kremer, Leontien C. M.
儿童、青少年和年轻人（CAYAs）癌症患者的生育保护护理在从业人员中并不统一。为了确保高质量的护理，循证临床实践指南（CPG）至关重要。作者确定了现有的CPG的生育力保存CAYA癌症，评估其质量，并探讨了recommends.METHODSA系统检索PubMed（2000年1月至2014年10月）的差异;指南数据库;和肿瘤学，儿科和生育组织的网站进行。两名评审员使用研究和评估指南评估II工具（AGREE II）评估了所确定的CPG的质量。从高质量的CPG中，作者评估了建议中的一致和不一致区域。AGREE II领域的平均得分（0%-100%）从适用性的15%到表述清晰度的100%不等。作者认为8个CPG（32%）是高质量的，定义为任何4个领域的得分60%。观察到的高质量的CPG的建议，87.2%和88.6%，分别是不一致的指导方针领域之间的生育力保存的建议，女性和男性cancer.CONCLUSIONSOnly约三分之一的识别CPG被发现是足够的质量。在这些CPG中，生育力保持建议差异很大，这可能反映了具体建议的证据不足，从而阻碍了提供者提供高质量护理的能力。CPG包括一个透明的生育保留决策过程，可以帮助医疗保健提供者提供最佳和统一的护理，从而提高癌症和癌症幸存者的CAYA的生活质量。Cancer 2016;122：2216-23. (c)2016作者出版社：Wiley Periodicals，Inc.只有大约三分之一的儿童，青少年和年轻成年人癌症患者生育力保存的临床实践指南被认为是足够的质量，并且在这些指南中，建议差异很大。这一发现支持需要为被诊断患有癌症的儿童和年轻人制定完善和透明的统一临床实践指南，这些儿童和年轻人有生育能力受损的风险。
BACKGROUNDFertility preservation care for children, adolescents, and young adults (CAYAs) with cancer is not uniform among practitioners. To ensure high-quality care, evidence-based clinical practice guidelines (CPGs) are essential. The authors identified existing CPGs for fertility preservation in CAYAs with cancer, evaluated their quality, and explored differences in recommendations.METHODSA systematic search in PubMed (January 2000-October 2014); guideline databases; and Web sites of oncology, pediatric, and fertility organizations was performed. Two reviewers evaluated the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II). From high-quality CPGs, the authors evaluated concordant and discordant areas among the recommendations.RESULTSA total of 25 CPGs regarding fertility preservation were identified. The average AGREE II domain scores (scale of 0%-100%) varied from 15% on applicability to 100% on clarity of presentation. The authors considered 8 CPGs (32%) to be of high quality, which was defined as scores 60% in any 4 domains. Large variations in the recommendations of the high-quality CPGs were observed, with 87.2% and 88.6%, respectively, of discordant guideline areas among the fertility preservation recommendations for female and male patients with cancer.CONCLUSIONSOnly approximately one-third of the identified CPGs were found to be of sufficient quality. Of these CPGs, the fertility preservation recommendations varied substantially, which can be a reflection of inadequate evidence for specific recommendations, thereby hindering the ability of providers to deliver high-quality care. CPGs including a transparent decision process for fertility preservation can help health care providers to deliver optimal and uniform care, thus improving the quality of life of CAYAs with cancer and cancer survivors. Cancer 2016;122:2216-23. (c) 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.Only approximately one-third of the identified clinical practice guidelines for fertility preservation in children, adolescents, and young adults with cancer were found to be of sufficient quality, and among these, the recommendations varied substantially. This finding supports the need for well-developed and transparent harmonized clinical practice guidelines for children and young adults diagnosed with cancer who are at risk of fertility impairment.