Transparency and Methodological Quality of Clinical Practice Guidelines in Palliative Care. Scoping Review

Palliative care (PC) and End-of-Life Care (EOLC) focus on improving the quality of life of patients with life-threatening illnesses by addressing physical, psychosocial, and spiritual needs. Clinical practice guidelines (CPGs) are essential for standardising care and supporting evidence-based clinical decision-making to improve patient outcomes but despite their importance, the methodological quality, transparency, and overall trustworthiness of CPGs require systematic evaluation. Given the limited assessment of CPGs in these areas, this study aimed to assess the methodological quality and transparency of CPGs in PC and EOLC for adult patients using the AGREE-II tool. Additionally, we evaluated the completeness of reporting using the RIGHT checklist.

We conducted a scoping review to map the existing clinical CPGs in PC and EOLC. A comprehensive search of MEDLINE, EMBASE, and multiple international guideline repositories was performed to identify relevant CPGs endorsed by professional organisations. Two reviewers independently screened, extracted data, and assessed the methodological quality and transparency using the AGREE II tool and the completeness of reporting using the RIGHT checklist. Discrepancies were resolved by consensus or a third reviewer. Descriptive analyses and inter-rater agreement were calculated.

A total of 6430 citations were identified and screened, resulting in the final inclusion of 23 CPGs. Over half (52.2%) focused exclusively on PC and were developed by governmental institutions. Based on AGREE-II assessment, 60.9% were classified as 'Recommended', 30.4% as 'Recommended with modifications'. The highest-scoring domains were Scope and Purpose (89%) and Clarity of Presentation (83%), while Applicability scored lowest (25%). Among the CPGs, 'IETS 2016 (Institute for Technological Assessment in Health, Colombia)' had the highest overall quality score (mean 96%), while 'CHPCA 2013 (Canadian Hospice Palliative Care Association, Canada)' had the lowest (mean 22%). Interrater agreement was good to excellent across most AGREE II domains, with the highest agreement for editorial independence (ICC = 0.87; 95% CI: 0.71-0.94) and the lowest for stakeholder involvement (ICC = 0.61; 95% CI: 0.29-0.81).

Several CPGs in PC and EOLC demonstrated significant gaps in applicability and transparency. To enhance their relevance and impact in clinical practice, improvements are needed in addressing real-world implementation challenges and providing clearer information on methodology, funding sources, and conflict of interest management.