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GYNAECOLOGY

Table 3. AGREE rating for cervical screening guidelines

Guideline

USPSTF,

ACS

ACOG

20023

20024

20035

NZGG 19986

ASCCP 20017

CTFPHE, NHMRC,

19948

20049

Overall objectives are described Clinical questions are described Patient population is described Guideline group represents individuals from professional groups Patients views and preferences have been sought Target users of the guideline are identified Guideline piloted among targeted users Systematic methods used to search for evidence Criteria for selecting the evidence are clearly described Methods for formulating recommendations clearly described Health benefits and risks have been considered in recommendations Recommendations and supporting evidence are linked Guideline externally reviewed by experts prior to publication A procedure for updating guideline is provided Recommendations are specific and unambiguous Different options for management clearly presented Key recommendations easily identifiable Guideline is supported with tools for application Potential barriers in applying recommendations have been discussed Potential cost implications of the recommendations have been considered Guideline presents key review criteria for monitoring Guideline is editorially independent from funding body Conflicts of interest of guideline development members recorded

SA D A SA D A D SA SA A A SA A D SA A SA D D A A A D

A D A A D A D SA A A A SA D D SA A A D D D A A D

D D A A D SA D SA D D A SA D D SA A A D D D A A D

A

SA

D

D

A

SA

A

SA

D

D

A

A

D

D

D

SA

D

SA

D

A

A

A

A

A

D

SA

A

D

SA

A

A

A

A

A

D

D

D

D

D

D

A

A

A

A

D

SA

D D A A D D D D D D A A D D A D A D D D D A D

A A A SA D A SA SA SA A A A SA A A A A D D D A A D

A: Agree; ACOG: American College of Obstetricians and Gynecologists; ACS: American Cancer Society; ASCCP: American Society of Colposcopy and Cervical Pathology; CTFPHE: Canadian Task Force on the Periodic Health Examination; D: Disagree; NHMRC: National Health and Medical Research Council; NZGG: New Zealand Guidelines Group; SA: Strongly agree; SD: Strongly disagree; USPSTF: United States Preventive Services Task Force.

respondents, 40 (73%) indicated that the draft practice guideline report was relevant to their clinical practice and completed the survey. Key results of the practitioner feed- back survey are summarized in Table 4.

In addition to the survey responses, 20 practitioners also provided written comments. The expert panel convened to discuss the comments and made modifications, when appropriate, to the draft.

Practice Guidelines Coordinating Committee Approval Process

members approved the report as written, but also requested that minor modifications be made. One member approved the report conditional on specific changes being made and requested a response from the Cervical Screening Guide- lines Development Committee. The remaining four mem- bers did not provide feedback on the report.

The expert panel reviewed and addressed the comments of the coordinating committee, making modifications to the text where necessary. The revised document was resubmit- ted to the coordinating committee and was approved for formal public distribution.

As a final quality control measure before publication and distribution, reports from the Program in Evidence-Based Care are circulated to a provincial committee, the Practice Guidelines Coordinating Committee. This is a multi- disciplinary group with expertise in cancer care and health methodology. The systematic review and practice guideline report on cervical screening was circulated to 13 members of the coordinating committee for review and approval. Five members approved the report as written. Three

Recommendations, listed in Appendix 1, were assigned evi- dence ratings (in brackets) based upon an established grad- ing system45 (Appendix 2).

DISCUSSION

Effecting change in the face of variable clinical practice and modest evidence from the health-care literature is a difficult and ongoing process. It is not realistic to expect that

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  • APRIL JOGC AVRIL 2007

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