Screening and diagnosis of oral cancer: a critical quality appraisal of clinical guidelines

Abstract

Objectives

To assess the quality of clinical practice guidelines (CPGs) on screening and diagnosis of oral cancer and to describe the characteristics of their recommendations.

Materials and methods

We systematically searched EMBASE, MEDLINE, CPG' websites, and dentistry and oncology scientific societies to identify CPGs that were related to screening and diagnosis of oral cancer. The quality of selected CPGs was independently assessed by four appraisers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The inter-appraiser agreement was assessed. We performed a descriptive analysis of the recommendations included in the selected CPGs.

Results

Eight CPGs were selected. The overall agreement among reviewers was considered very good (ICC: 0.823; 95% CI: 0.777–0.861). The median scores of the six AGREE II domains were as follows: "scope and purpose" 97.9% (IQR: 96.2–100.0%); "stakeholder involvement" 86.1% (IQR: 69.8–93.1%); "rigor of development" 75.3% (IQR: 64.2–94.3%); "clarity of presentation" 91.7% (IQR: 82.6–94.4%); "applicability" 53.1% (IQR: 19.3–74.2%); and "editorial independence" 83.3% (IQR: 67.2–93.8%). Four CPGs were assessed as "recommended", four "recommended with modifications", and none "not recommended". Twenty-three recommendations were provided, mostly with a low or very low level of evidence.

Conclusion

The methodological quality of CPGs on screening and diagnosis of oral cancer is moderate. The "applicability" domain scored the lowest. Most recommendations were based on a low o very low level of evidence.

Clinical relevance

Greater efforts are needed to provide healthcare based on high-quality evidence-based CPGs in this field.

https://ift.tt/2O08qZX