Quality of clinical practice guidelines in dermatological oncology

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 & 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  < 0.05; Table 2). 1 Standardized domain scoresAuthorCountryYear of publicationScope & PurposeStakeholdersRigourClarityApplicabilityEditorial IndependenceDrake 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  6Telfer 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 33 332 Statistics(A) Median standardized domain score of guidelines published before the AGREE instrument (< 2002)Guidelines before AGREE, n  = 12MedianPercentile <>Scope & Purpose 77.5 < 67.0 97.3 > Stakeholders 31.0 < 25.0 44 > Rigour 39.5 < 16.5 64.0 > Clarity 58 < 29.3 66.0 > Applicability  0 < 0 11 > Editorial Independence  4 < 0 33 >(B) Median standardized domain score of guidelines published after the AGREE instrumentGuidelines after AGREE, n  = 11MedianPercentile <>Scope & Purpose 83 < 56.0 100.0 > Stakeholders 38 < 25.0 75.0 > Rigour 45 < 29.0 69.0 > Clarity 67 < 58.0 71.0 > Applicability 39 < 0 50.0 > Editorial Independence  0 < 0 0 >(C) Guidelines published before AGREE and guidelines published after AGREE. Using non‐parametric Mann–Whitney t ‐testDomainP  

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