(30) Quality Assessment of Latest National Comprehensive Cancer Network Guidelines Using The AGREE-II Instrument and RIGHT Statement

Publication Number: 1075

Background: National Comprehensive Cancer Network (NCCN) is the most authoritative organization in the USA for developing guidelines and has a strategy to update their Clinical practice guidelines (CPGs) at least annually. CPGs have the potential to improve the quality of patient care and patient outcomes, but embracing low-quality guidelines may result in widespread use of inefficient practices and harm to patients. The increasing use of CPGs growth, as well as concerns about their quality, has prompted for the assessment of the quality of guidelines and their reporting.

Objectives: To assess the quality of latest guidelines published by the NCCN.

Methods: We included guidelines published by the NCCN in the year 2020. Two authors independently assessed CPGs by using two popular quality assessment tools AGREE-II (Appraisal of Guidelines for Research & Evaluation) and RIGHT (Reporting Items for Practice Guidelines in Health Care) Statement. Disagreements between the authors were resolved by consensus with a third author. Data extraction was performed using Microsoft Excel. Based on the score obtained for each CPG, quality of the guidelines was evaluated.

Results: A total of 59 CPGs were identified. We assessed scores of all CPGs by using AGREE II. Compared to other domains, the domains “Clarity of presentation" & “Editorial independence" scored high with mean percent scores of 81.4% and 95.8%, respectively. The domain clarity of presentation includes whether the recommendations are specific and clear, key recommendations are easily identifiable or not. Editorial independence includes funding and conflicts of interests. The domain “Stakeholder involvement” scored the lowest among all domains with mean percent score of 49%. It includes regarding guideline developing group, values and preferences of the patients. In the assessment that used the RIGHT statement, the domain “Funding and interest” reported highest among all domains with mean percent score of 100% and includes about conflict of interests. The domains “Evidence” and “Recommendations”, reported lowest for all CPGs with mean percent scores of 30% and 49.8%, respectively. Evidence includes whether the guideline is based on approach used to assess the certainty of body of evidence and recommendations includes whether guidelines provide clear, precise and actionable recommendations. Overall assessment for all CPGs shows “Recommend with modifications”.

Conclusions: Our findings suggested that overall quality of the NCCN guidelines was moderate and recommended with some modifications. Each guideline contained strengths and limitations, and improving these limitations (improvements in stakeholder involvement, recommendations and evidence domains) will enhance the relevance of the NCCN recommendations.