Systems for grading the strength of recommendations in clinical practice guidelines in oncology
, 1, 1, 1, 1, 1, 1
Abstract
Introduction. In order to improve the applicability of clinical practice guidelines, their authors assign recommendations with grades denoting the degree of conviction regarding their practical application. Nevertheless even within one branch of medicine, significant differences between the grading systems arise.
Material and methods. To identify these systems, websites of societies and institutions publishing oncology guidelines were searched. Only high-quality, regularly updated guidelines were included.
Results. Five systems were analysed – all incorporate quality of evidence and strength of recommendation, but vary in the methods of their assessment and structure of the scales.
Discussion. The described systems depend on the review of data, the quality of which supports the ascribed strength. Systems differ with regard to the methods of assessing the quality, quantity and consistency of evidence, potentially leading to assigning different grades of strength to recommendations based on the same studies.
Conclusions. The introduction of unified grading systems across each branch of medicine could aid the development of unambiguous recommendations that are easy to introduce within the healthcare system.
Keywords: grading systemguidelinesrecommendationquality of evidencestrength of recommendation
References
- Graham R, Mancher M, Wolman DM, et al. (ed.). Clinical Practice Guidelines We Can Trust. Washington (DC): National Academies Press (US) 2011. https://www.ncbi.nlm.nih.gov/books/NBK209539/ (2.12.2020).
- Leśniak W, Bała M, Jaeschke R, et al. Od danych naukowych do praktycznych zaleceń – tworzenie wytycznych według metodologii GRADE. Polish Archives of Internal Medicine. 2015; 125(Special Issue): 26–41.
- Jaeschke R, Guyatt G, Cook C. POWAP – czyli praktyka medyczna oparta na wiarygodnych i aktualnych publikacjach. Ewaluacja Badań Medycznych – Evidence Based Medicine (EBM). Medycyna Praktyczna 1999.
- Koperny M, Maciorowska K, Leśniak W, et al. Clinical guidelines development process in Poland. Przegl Epidemiol. 2017; 71(4): 647–659.
- Gronseth GS, Cox J, Gloss D et al. Clinical Practice Guideline Process Manual. 2017 Edition. https://tools.aan.com/siteassets/home-page/policy-and-guidelines/guidelines/about-guidelines/17guidelineprocman_pg.pdf (2.12.2020).
- Szczeklik A, Gajewski P. Interna Szczeklika–Podręcznik chorób wewnętrznych. Medycyna Praktyczna, Kraków 2014: 2575–2600.
- Brouwers MC, Kho ME, Browman GP, et al. AGREE Next Steps Consortium, AGREE Next Steps Consortium, AGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010; 182(18): E839–E842.
- Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64(4): 383–394.
- Guyatt G, Oxman AD, Sultan S, et al. GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol. 2013; 66(2): 151–157.
- Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength. J Clin Epidemiol. 2013; 66(7): 726–735.
- Gopalakrishna G, Mustafa RA, Davenport C, et al. Applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to diagnostic tests was challenging but doable. J Clin Epidemiol. 2014; 67(7): 760–768.
- Hartling L, Fernandes RM, Seida J, et al. From the trenches: a cross-sectional study applying the GRADE tool in systematic reviews of healthcare interventions. PLoS One. 2012; 7(4): e34697.
- The National Comprehensive Cancer Network. (b.d.). About the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). https://www.nccn.org/professionals/default.aspx (2.12.2020).
- The National Comprehensive Cancer Network. (b.d.). Development and Update of the NCCN Guidelines®. https://www.nccn.org/professionals/development.aspx (2.12.2020).
- Wayant C, Cooper C, Turner D, et al. Evaluation of the NCCN guidelines using the RIGHT Statement and AGREE-II instrument: a cross-sectional review. BMJ Evid Based Med. 2019; 24(6): 219–226.
- The National Institute for Health and Clinical Excellence. Developing NICE guidelines: the manual, 2018. https://www.nice.org.uk/process/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869 (2.12.2020).
- European Society for Medical Oncology (ESMO). SOPs/Instructions for Authors and templated for standard ESMO Clinical Practice Guidelines (CPGs) and ESMO-MCBS Scores, 2020. https://www.esmo.org/content/download/77789/1426712/file/ESMO-Clinical-Practice-Guidelines-Standard-Operating-Procedures.pdf (31.11.2020).
- Pentheroudakis G, Cardoso F, Arnold D, et al. ESMO Guidelines Committee. The ESMO guideline strategy: an identity statement and reflections on improvement. Ann Oncol. 2015; 26 Suppl 5: v1–v7.
- Scottish Intercollegiate Guidelines Network (SIGN). SIGN 50: a guideline developer’s handbook. Edinburgh: SIGN 2019; (SIGN publication no. 50). https://www.sign.ac.uk/assets/sign50_2019.pdf (31.11.2020).
- McSweeney LA, Wilson JA, Wilkes S, et al. Is Scottish Intercollegiate Guidelines Network guidance for GP management of tonsillitis suitable? A qualitative study. Fam Pract. 2018; 35(5): 633–637.