Risk of Bias and Quality of Reporting in Colon and Rectal Cancer Systematic Reviews Cited by National Comprehensive Cancer Network Guidelines

Wayant, Cole; Puljak, Livia; Bibens, Michael; Vassar, Matt

doi:10.1007/s11606-020-05639-y

Cited by 13 publications

(6 citation statements)

References 19 publications

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“…If we are to improve clinical practice, the evidence underpinning guideline recommendations must be rigorously developed and evaluated [16,17]. Non-systematic methodology to gather, appraise, and synthesise evidence may lead to biased results and over-or under-estimation of treatment effect estimates, which are especially harmful when used to support guideline recommendations [18]. For example, in 2016, the Canadian Association of Radiologists (CAR) issued a guideline calling for women with average breast cancer risk to begin screening mammography at age 40 [19], in contrast to US Preventive Services Task Force [20] or the American Academy of Family Physicians [21] recommendations published in the same year.…”

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confidence: 99%

Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

et al. 2021

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Introduction Assessing the process used to synthesize the evidence in clinical practice guidelines enables users to determine the trustworthiness of the recommendations. Clinicians are increasingly dependent on guidelines to keep up with vast quantities of medical literature, and guidelines are followed to avoid malpractice suits. We aimed to assess whether systematic methods were used when synthesizing the evidence for guidelines; and to determine the type of review cited in support of recommendations. Methods Guidelines published in 2017 and 2018 were retrieved from the TRIP and Epistemonikos databases. We randomly sorted and sequentially screened clinical guidelines on all topics to select the first 50 that met our inclusion criteria. Our primary outcomes were the number of guidelines using either a systematic or non-systematic process to gather, assess, and synthesise evidence; and the numbers of recommendations within guidelines based on different types of evidence synthesis (systematic or non-systematic reviews). If a review was cited, we looked for evidence that it was critically appraised, and recorded which quality assessment tool was used. Finally, we examined the relation between the use of the GRADE approach, systematic review process, and type of funder. Results Of the 50 guidelines, 17 (34%) systematically synthesised the evidence to inform recommendations. These 17 guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. Of the 29/50 guidelines that included reviews, 6 (21%) assessed the risk of bias of the review. The quality of primary studies was reported in 30/50 (60%) guidelines. Conclusions High quality, systematic review products provide the best available evidence to inform guideline recommendations. Using non-systematic methods compromises the validity and reliability of the evidence used to inform guideline recommendations, leading to potentially misleading and untrustworthy results.

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confidence: 99%

Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

et al. 2021

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“…A third limitation is that our findings apply to this particular research question, and may not be generalizable to other populations, disease areas, or interventions. However, the plethora of publications addressing the low quality of SRs affirms our suspicion that this is a widespread problem 8,37–47 …”

Section: Discussionmentioning

confidence: 83%

“…We found inconsistent reporting and methodological quality in SRs on the clinical impact of poor ART adherence, despite the availability of numerous reporting guidelines (eg, PRISMA) and quality/RoB assessment tools (eg, AMSTAR 2, Critical Appraisal Skills Programme [CASP], Cochrane's RoB in Nonrandomized Studies of Interventions [ROBINS‐I], Newcastle Ottawa Scale, the Scottish Intercollegiate Guidelines Network [SIGN], and Mixed Methods Appraisal tool [MMAT]) 8,14,36 . Other researchers have reported similar findings in other medical specialties 8,37–47 . The poor quality we observed may explain the lack of reliance on these SRs in the US DHHS HIV treatment guideline 7 .…”

Section: Discussionmentioning

confidence: 98%

Quality of systematic reviews in HIV: The case of clinical outcomes associated with patient medication adherence

Lake

Lawrence

Alonso

et al. 2021

J Evidence Based Medicine

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Aim Use of systematic reviews (SRs) as first‐level evidence for guideline recommendations hinges on review quality. In particular, US guidelines for adherence‐related recommendations in the treatment of human immunodeficiency virus (HIV) are not based on available SRs of adherence‐outcome relationships; it is unclear why. No published studies report on the quality of SRs on HIV adherence and outcomes, which may be driving the lack of use. We describe the quality of this body of literature. Methods Literature searches were conducted in Ovid MEDLINE, EMBASE, CINAHL, PubMed Central, the Cochrane Library, Science Citation Index, Web of Science, ScIELO Citation Index, and Ovid Emcare. Screening and quality assessments were performed in duplicate using AMSTAR 2. Funding sources and impact factors of publishing journals were also extracted, and correlations between quality rankings and numbers of critical weaknesses versus impact factors were assessed using Spearman's rank correlation coefficient. Results Nine SRs of 1141 records met eligibility criteria. Overall confidence in the results was critically low for most (78%) SRs. Underperformance was found across all AMSTAR 2 domains. Impact factor (a surrogate or journal reputation) did not correlate with quality. Conclusions SRs do not necessarily comprise top‐level evidence despite the availability of quality appraisal tools and reporting guidance, which could explain the lack of SR evidence in US HIV medication adherence‐related guideline recommendations. All parties to evidence synthesis publication should require quality assessment of studies.

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“…According to Lunny and associates [ 61 ], high-quality systematic review products are required for the identification and pooling of the best available up-to-date evidence in order to inform clinical recommendations. The use of non-systematic methods, as seen in the EAT- Lancet report [ 7 ], may greatly compromise the validity and reliability of the evidence used to inform the formulation of recommendations—let alone global nutritional policy recommendations—and ultimately leads to over- or under-estimation of the treatment effect estimates and potentially untrustworthy and misleading recommendations [ 61 , 63 ].…”

Section: The Eat- Lancet Reference Dietmentioning

confidence: 99%

Basics of Sustainable Diets and Tools for Assessing Dietary Sustainability: A Primer for Researchers and Policy Actors

et al. 2022

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Climate change can have economic consequences, affecting the nutritional intake of populations and increasing food insecurity, as it negatively affects diet quality parameters. One way to mitigate these consequences is to change the way we produce and consume our food. A healthy and sustainable diet aims to promote and achieve the physical, mental, and social well-being of the populations at all life stages, while protecting and safeguarding the resources of the planet and preserving biodiversity. Over the past few years, several indexes have been developed to evaluate dietary sustainability, most of them based on the EAT-Lancet reference diet. The present review explains the problems that arise in human nutrition as a result of climate change and presents currently available diet sustainability indexes and their applications and limitations, in an effort to aid researchers and policy actors in identifying aspects that need improvement in the development of relevant indexes. Overall, great heterogeneity exists among the indicators included in the available indexes and their methodology. Furthermore, many indexes do not adequately account for the diets’ environmental impact, whereas others fall short in the economic impact domain, or the ethical aspects of sustainability. The present review reveals that the design of one environmentally friendly diet that is appropriate for all cultures, populations, patients, and geographic locations is a difficult task. For this, the development of sustainable and healthy diet recommendations that are region-specific and culturally specific, and simultaneously encompass all aspects of sustainability, is required.

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Risk of Bias and Quality of Reporting in Colon and Rectal Cancer Systematic Reviews Cited by National Comprehensive Cancer Network Guidelines

Cited by 13 publications

References 19 publications

Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study

Quality of systematic reviews in HIV: The case of clinical outcomes associated with patient medication adherence

Basics of Sustainable Diets and Tools for Assessing Dietary Sustainability: A Primer for Researchers and Policy Actors

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