Simcha Weissman1, Alexander Goldowsky2, Muhammad Aziz3, Tej I Mehta4, Sachit Sharma5, Megan Lipcsey2, Trent Walradt2, Umair Iqbal6, Sameh Elias1, Joseph D Feuerstein7. 1. Department of Medicine, Hackensack Meridian Health, Palisades Medical Center, North Bergen, NJ, USA. 2. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 3. Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA. 4. Department of Medicine, Medical College of Wisconsin, Madison, WI, USA. 5. Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA. 6. Department of Medicine, Geisinger Medical Center, Danville, PA, USA. 7. Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. jfeuerst@bidmc.harvard.edu.
Abstract
BACKGROUND: Owning to colorectal cancer's (CRC) high mortality, multiple societies developed screening guidelines. AIMS: We aimed to assess the overall quality of CRC screening guidelines. METHODS: A systematic search was performed to review CRC screening guidelines for conflicts of interest (COI), recommendation quality and strength, external document review, use of patient representative, and recommendation age-as per Institute of Medicine (IOM) standards. In addition, recommendations were compared between guidelines/societies. Statistical analysis was conducted using R. RESULTS: Twelve manuscripts were included in final analysis. Not all guidelines reported on COI, provided a grading method, underwent external review, or included patient representation. 14.5%, 34.2%, and 51.3% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 27.8%, 54.6%, and 17.5% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence and strong recommendations did not significantly differ across societies, nor were significant associations between publication year and evidence quality seen (P = 0.4). CONCLUSIONS: While the majority of the CRC guidelines contain aspects of the standards set forth by the IOM, there is an overall lack of adherence. As over 85% of recommendations are based on low-moderate quality evidence, further studies on CRC screening are warranted to improve the overall quality of evidence.
BACKGROUND: Owning to colorectal cancer's (CRC) high mortality, multiple societies developed screening guidelines. AIMS: We aimed to assess the overall quality of CRC screening guidelines. METHODS: A systematic search was performed to review CRC screening guidelines for conflicts of interest (COI), recommendation quality and strength, external document review, use of patient representative, and recommendation age-as per Institute of Medicine (IOM) standards. In addition, recommendations were compared between guidelines/societies. Statistical analysis was conducted using R. RESULTS: Twelve manuscripts were included in final analysis. Not all guidelines reported on COI, provided a grading method, underwent external review, or included patient representation. 14.5%, 34.2%, and 51.3% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 27.8%, 54.6%, and 17.5% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence and strong recommendations did not significantly differ across societies, nor were significant associations between publication year and evidence quality seen (P = 0.4). CONCLUSIONS: While the majority of the CRC guidelines contain aspects of the standards set forth by the IOM, there is an overall lack of adherence. As over 85% of recommendations are based on low-moderate quality evidence, further studies on CRC screening are warranted to improve the overall quality of evidence.
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