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The development of oncology treatment guidelines: an analysis of the National Guidelines Clearinghouse
1Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Purpose:
In the last 2 decades, guidelines have been developed to improve quality of patient care. A recent editorial of guideline development procedures suggested the process has significant limitations that affect their scientific validity.(1) This prompted us to review oncology treatment guidelines to determine if such limitations are widespread.
Methods And Materials:
We performed a review of oncology treatment guidelines registered at the National Guidelines Clearinghouse (www.guideline.gov). Each guideline was independently reviewed by 2 authors and the following criteria were assessed: coordinating organization, guideline panel composition, reporting conflict of interest, peer review, dissent, expiration date, PubMed citation, and evidence-based scoring and grading of recommendations. Disagreements were resolved by consensus in subsequent discussions.
Results:
Sixty-four guidelines were reviewed (39 [61%] were developed by a medical specialty society and 25 [39%] were developed by government agencies). Fifty (78%) guideline panels were multidisciplinary and 44 (69%) included individuals with epidemiologic and health services research expertise. Potential conflicts of interest were disclosed in 43 (67%) guidelines. Sixty (94%) guidelines underwent peer review, with external review in 31 (48%). Seventeen (27%) guidelines are indexed by PubMed. Fifty-one (80%) guidelines included evidence-based methodologies and 46 (72%) used evidence-based scoring of recommendations. Significant differences were observed according to coordinating organization (eg, disclosure of conflict of interest in 46% of guidelines developed by medical specialty societies versus 100% authored by government agencies [P <.0001]).
Conclusions:
The majority of oncology-related treatment guidelines registered at the National Guidelines Clearinghouse satisfy most of the criteria for sound guideline development. Significant differences in these criteria were observed according to the coordinating organization that developed the guideline.
Insights
Oncology treatment guidelines generally meet criteria for sound development, but quality varies by the developing organization. This review assessed guideline validity and found differences in conflict of interest reporting.
Area of Science:
- Medical guidelines
- Oncology
- Healthcare quality
Background:
- Guidelines aim to improve patient care quality.
- Concerns exist regarding the scientific validity of guideline development processes.
- Previous research highlighted potential limitations in guideline creation.
Purpose of the Study:
- To review oncology treatment guidelines for widespread limitations in their development.
- To assess the scientific validity of oncology guidelines.
- To identify variations in guideline development practices.
Main Methods:
- Reviewed 64 oncology treatment guidelines from the National Guidelines Clearinghouse.
- Assessed criteria including panel composition, conflict of interest, peer review, and evidence-based scoring.
- Two authors independently reviewed each guideline, resolving disagreements by consensus.
Main Results:
- Most guidelines (78%) had multidisciplinary panels; 69% included research expertise.
- Conflict of interest disclosed in 67%; peer review in 94%.
- Significant differences observed based on coordinating organization, particularly in conflict of interest disclosure (46% vs. 100%).
Conclusions:
- The majority of oncology guidelines meet most criteria for sound development.
- Significant variations exist in guideline development practices based on the coordinating organization.
- Further investigation into organizational differences may improve guideline validity.
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