Quality of clinical practice guidelines in dermatological oncology

Abstract Background Clinical practice guidelines are increasingly used. To determine the quality of guidelines the Appraisal of Guidelines and Research and Evaluation (AGREE) instrument was developed and introduced in 2001. The AGREE instrument consists of 23 criteria, grouped in six domains. Objective Assessment of quality of evidence‐based guidelines in dermatological oncological care according to the AGREE instrument. Methods We searched MEDLINE, PubMed, EMBASE and Cochrane literature and relevant websites of guidelines development programmes and the national dermatological society to identify evidence‐based dermatological guidelines especially in the treatment of to basal cell carcinoma, squamous cell carcinoma and melanoma. Twenty guidelines, published between 1990 and 2005, were appraised according to the AGREE instrument by three authors. Standardized domain scores were calculated as advised by AGREE. We compared guidelines published before 2002 with those published later. Results Domain scores in the domains Scope &amp; Purpose and Clarity were scored best. Applicability and Editorial Independence were scored worst (see Table 1 ). In time a weak trend towards better guidelines was seen. This trend can be attributed to better scores in the domains Search Strategy and Level of Evidence which are closely related to evidence‐based medicine. The increase in score is due to more explicitly mentioning the search strategy, possible conflict of interest and involvement of different specialties in development of the guideline. Using the Mann–Whitney test to compare guidelines published before the AGREE and afterwards only a statistically significant better score was found for the domain Clarity ( P &lt; 0.05; Table 2 ). Standardized domain scores Author Country Year of publication Scope &amp; Purpose Stakeholders Rigour Clarity Applicability Editorial Independence Drake USA 1992 28 21 5 13 0 0 Drake USA 1993 72 25 14 25 0 0 Drake USA 1995 67 25 5 25 0 0 De Ruiter Netherlands 1997 33 21 29 66 11 3 Cox UK 1999 67 33 24 46 6 Telfer UK 1999 89 29 43 58 28 0 Reeve Australia 1999 100 100 88 71 44 0 Negrier France 2000 72 46 48 66 0 50 Dummer Switzerland 2001 83 63 36 63 0 8 Cook USA 2001 83 25 67 58 11 50 Sober USA 2001 100 38 67 67 0 33 Sober USA 2001 100 33 55 42 0 0 Motley UK 2002 83 25 45 58 0 33 Motley UK 2002 89 38 40 67 0 0 Roberts UK 2002 78 33 45 58 0 0 Roberts UK 2002 100 50 29 71 61 0 Marks Australia 2002 100 100 57 71 50 0 Beljaards Netherlands 2003 78 54 88 67 44 0 Doherty Scotland 2004 89 88 69 88 39 75 Rademaker New Zealand 2004 11 25 17 50 0 0 Houghton USA 2004 56 33 52 67 44 0 Quirt Canada 2004 100 75 93 71 56 58 Miller USA 2004 33 4 21 38 0 0 De Ruiter Netherlands 2005 62 54 95 79 33 33 Statistics (A) Median standardized domain score of guidelines published before the AGREE instrument (&lt; 2002) Guidelines before AGREE, n = 12 Median Percentile &lt; &gt; Scope &amp; Purpose 77.5 &lt; 67.0 97.3 &gt; Stakeholders 31.0 &lt; 25.0 44 &gt; Rigour 39.5 &lt; 16.5 64.0 &gt; Clarity 58 &lt; 29.3 66.0 &gt; Applicability 0 &lt; 0 11 &gt; Editorial Independence 4 &lt; 0 33 &gt;</jat

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