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Guidelines for uveal melanoma: a critical appraisal of systematically identified guidelines using the AGREE II and
Theresa Steeb1, Kinan M Hayani2, Paul Förster3
1Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.
Purpose:
Clinical practice guidelines provide recommendations for the management of diseases. In orphan conditions such as uveal melanoma (UM), guideline developers are challenged to provide practical and useful guidance even in the absence of high-quality evidence. Here, we assessed the methodological quality and identified deficiencies of international guidelines on UM as a base for future guideline development.
Methods:
A systematic search was carried out in guideline databases, Medline and Embase until 27th May 2019 for guidelines on UM published between 2004 and 2019. Five independent reviewers assessed the methodological quality of the identified guidelines using the instruments "Appraisal of Guidelines for Research and Evaluation II" (AGREE II) and AGREE-REX (Recommendation EXcellence). Descriptive analysis was performed and subgroup differences were explored with the Kruskal-Wallis (H) test. The relationship between the individual domains and items of the instruments were examined using Spearman's correlation.
Results:
Five guidelines published from 2014 to 2018 by consortia of the United States of America, Canada and the United Kingdom (UK) were included. The highest scores were obtained by the UK guideline fulfilling 48-86% of criteria in AGREE II and 30-60% for AGREE-REX. All guidelines showed deficiencies in the domains "editorial independence", "applicability", and "recommendation". Subgroup differences were identified only for the domain "editorial independence".
Conclusion:
The UK guideline achieved the highest scores with both instruments and may serve as a basis for future guideline development in UM. The domains "editorial independence", "recommendation", and "applicability" were identified as methodological weaknesses and require particular attention and improvement in future guidelines.
Insights
This study evaluated international uveal melanoma (UM) guidelines, finding the UK guideline strongest. Future UM guidelines should improve editorial independence, applicability, and recommendations for better clinical practice.
Area of Science:
- Ophthalmology
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Clinical practice guidelines are crucial for disease management, especially for rare conditions like uveal melanoma (UM).
- Developing high-quality guidelines for UM is challenging due to limited evidence.
- This study aimed to assess the quality of existing international UM guidelines.
Purpose of the Study:
- To evaluate the methodological quality of international uveal melanoma (UM) guidelines.
- To identify specific deficiencies in current UM guidelines.
- To provide a foundation for future UM guideline development.
Main Methods:
- A systematic search identified UM guidelines published between 2004 and 2019.
- Five independent reviewers used AGREE II and AGREE-REX instruments to assess methodological quality.
- Statistical analyses, including Kruskal-Wallis and Spearman correlation, were employed.
Main Results:
- Five guidelines from the US, Canada, and UK (2014-2018) were analyzed.
- The UK guideline scored highest on both AGREE II and AGREE-REX.
- All guidelines had weaknesses in editorial independence, applicability, and recommendation domains.
Conclusions:
- The UK's uveal melanoma guideline is a potential model for future development.
- Key areas for improvement in UM guidelines include editorial independence, applicability, and recommendation quality.
- Addressing these methodological weaknesses will enhance the utility of future UM guidelines.
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