Premium
Improving the applicability of guidelines on nonmelanoma skin cancer in frail older adults: a multidisciplinary expert consensus and systematic review of current guidelines
Author(s) -
Lubeek S.F.K.,
Borgonjen R.J.,
Vugt L.J.,
Olde Rikkert M.G.,
Kerkhof P.C.M.,
Gerritsen M.J.P.
Publication year - 2016
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14923
Subject(s) - medicine , multidisciplinary approach , guideline , medline , skin cancer , nice , delphi method , family medicine , cancer , pathology , social science , statistics , mathematics , sociology , political science , computer science , law , programming language
Summary Background Balancing treatment decisions in frail older adults with nonmelanoma skin cancer ( NMSC ) can be challenging. Clinical practice guidelines ( CPG s) could provide assistance. Objectives To collect and prioritize items related to frail older adults with NMSC for integration into CPG s and to assess the current extent of this integration. Methods Items were collected and prioritized by a multidisciplinary working group (29 members) using a modified Delphi procedure and a five‐point Likert scale. To assess current integration of these items in CPG s, a systematic review was subsequently performed by two independent reviewers using five medical databases (PubMed, Embase, Cochrane Library, SUM search and Trip Database), websites of guideline developers/databases, and (inter)national dermatological societies. Results Prioritization of a final 13‐item list showed that ‘limited life expectancy’ (4·5 ± 0·9) and ‘treatment goals other than cure’ (4·4 ± 0·7) were most desired to be integrated into CPG s; both were included in six (46%) of the CPG s found ( n = 13). Attention to ‘tumour characteristics’ and ‘comorbidities’ were included in CPG s most often (100% and 77%, respectively). Conclusions More attention to items related to frail older adults in NMSC CPG s is broadly desired, but CPG integration of these items is currently limited. More integration might stimulate more holistic, personalized and patient‐centred care in frail older adults.