Tools / Cancer Guidelines Database Cancer Guidelines DatabaseAccess quality cancer guidelines from a single Canadian source View All Cancer Guidelines Browse by category About the database About the AGREE II score Cancer type Discover guidelines organized by type of cancer for quick access Continuum of care Access guidelines based on the different areas of the cancer system Location geographic-specificity-caption How the database began The Cancer Guidelines Database is a searchable database of approximately 1,000 English-language cancer control guidelines. This database was first called the Standards and Guidelines Evidence (SAGE) directory. It was created by Dr. Melissa Brouwers and her research team at McMaster University with Partnership funding. Since 2014, The Partnership has worked with the Centre for Effective Practice to refresh the database with revised methodology and enhanced indexing. The database is updated quarterly (January, April, July, October). Guidelines for cancer control Cancer guidelines are a core strategy in cancer control. They compile the best available evidence on specific health-care options. As well, guidelines provide a basis for consistent, high-quality cancer care that can help improve patient outcomes. This database’s guidelines address all stages of the cancer continuum, from screening to survivorship and end-of-life care. We’ve reviewed and appraised the database’s guidelines for quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument, the current gold standard in guideline quality appraisal. The Canadian Partnership Against Cancer does NOT develop guidelines. This database has indexed quality guidelines and select guidance documents from key organizations. For more information see the agreetrust.org. Goal The database’s goal is to inform decision making that is evidence-based. This database’s clinical practice guidelines (CPGs) can help groups strategize over the best use of human and financial resources for policy or practice change. Audience The following roles may find this database helpful: Clinicians who want to stay up-to-date on the latest recommendations for high-quality cancer control care Policy makers who are interested in high-quality evidence-based resources to inform decision-making processes and policies System leaders who are interested in using guidelines as part of an overall mandate to improve quality Researchers who want to identify potential gaps in the cancer control field for future research Guideline developers who want to improve their guidelines’ quality, reduce duplication, facilitate adaptation or promote sharing (to learn more about quality guideline development visit agreetrust.org. Three types of database records This database includes three types of records. For more detailed information see About the AGREE II Score. High-quality clinical practice guidelines are included that have a score 60 per cent or above on the AGREE II Rigour of Development domain. High-quality guidelines display the AGREE II scores for all 6 domains. Moderate-quality clinical practice guidelines are included that score below 60 per cent on the AGREE II Rigour of Development domain. Moderate-quality guidelines do not display a full AGREE score, but meet the database’s criteria for being included. Guidance documents from key Canadian and provincial cancer-focused organizations are included that don’t provide explicit recommendations linked to evidence, or don’t refer to a literature search which supports the content of the document. These organizations are given special consideration given their role in the cancer control system in Canada and are included without a quality appraisal and therefore DO NOT have an AGREE II score. See a list of these organizations here. What each record includes Each entry in this database includes: Details about the guideline and its developer A short description about the guideline Which type(s) of cancer the guideline addresses AGREE II quality appraisal scores (for high quality and moderate quality guidelines) A link to the full-text version of the guideline or journal, if available Each guideline is indexed using additional metadata such as location and continuum of care to improve search functionality How to search this database First, search with relevant keywords. Then, filter results by: Type of cancer Continuum of care AGREE II score Search results display in order of relevance. To see only higher-quality clinical practice guidelines, use the “AGREE II score” filter. How are guidelines identified and selected? Guidelines are defined as documents that provide explicit recommendations, include a search of the relevant literature and are developed by a medical/health organization, professional society, government agency or expert panel at the international, national, provincial/territorial, regional or organization level. The following databases and sites are reviewed for publicly available English language clinical practice guidelines that can be included in this database: Biomedical databases, such as MEDLINE Specialized guideline repositories including CPG Infobase and the G-I-N Library Websites of Canadian and international agencies and networks that develop guidelines Provincial, territorial, national and international organizations that address the cancer care continuum What is the inclusion criteria and how are guidelines and/or guidance documents evaluated? Figure 1: Cancer Guidelines Workflow A guideline must meet criteria in section A or B to be included in the database. A) Canadian and international guidelines published in English that: Address a topic within the cancer care continuum Are developed by a medical or health organization, professional society, government agency or expert panel at the international, national, provincial, territorial, regional or organizational level Refer to a literature search supporting the guideline Provide explicit recommendations based on evidence Recommendations are statements that describe when an action or intervention should or should not be performed, and must be identifiable within the guideline For a recommendation to be considered as evidence-based it must provide a clear link to supporting evidence, including: A level of evidence or strength of recommendation from a system such as GRADE A statement that clearly summarizes the published literature supporting the recommendation, which includes information about the body of evidence’s quality, quantity, or consistency (For example, “Two high-quality RCTs were identified that support this recommendation… the level of certainty of the evidence was deemed high, and the magnitude of net health benefit from avoiding potentially ineffective and harmful treatment, along with promoting more immediate access to what could be the next most effective treatment, is at least moderate…”) Note: Consensus recommendations can satisfy these criteria if rationale is provided for why they are based on consensus, such as a statement describing the lack of published or good-quality evidence in the area. Most grading systems include specific levels of evidence for consensus recommendations B) Guidance documents included in the database from key Canadian and provincial cancer-focused organizations. Through stakeholder consultation, the Partnership has identified key national and provincial cancer-focused organizations that produce guidance documents. These organizations are uniquely suited to provide guidance that is relevant at national and local settings. Key Canadian and provincial cancer-focused organizations are given special consideration for their guidance documents, which are included in the database even if they don’t meet the formal criteria outlined. These documents will NOT undergo a quality assessment using the AGREE II and therefore AGREE II scores are NOT provided. These organizations include: Alberta Health Services – Provincial Tumour Teams Atlantic Provinces Pediatric Hematology Oncology Network BC Cancer Agency C17 Council Canadian Partnership Against Cancer CancerCare Manitoba Cancer Care Nova Scotia Cancer Care Ontario Eastern Health Cancer Care Program New Brunswick Cancer Network Pediatric Oncology Group of Ontario Saskatchewan Cancer Agency Submissions We encourage guideline developers to submit their cancer-control guidelines or standards to be included in this database. Please contact us for more information. Why do some guidelines/guidance documents have an AGREE II score and others do not? Only guidelines that meet the inclusion criteria and are assessed as high or moderate quality have AGREE II scores associated with their record. Guidance Documents, those that do not meet the criteria of a clinical practice guideline, are included if they are developed by an organization on our list but do not undergo an AGREE II assessment. How we evaluate guidelines for quality We’ve evaluated the guidelines in this database by using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Both guideline developers and users world-wide use AGREE II’s framework to: Assess a guideline’s methodological rigour and transparency Provide a methodological strategy for developing guidelines Inform the type of information guidelines should report and how How AGREE II works AGREE II consists of 23 items that target the quality of practice guidelines in six areas: Scope and purpose Stakeholder involvement Rigour of development Clarity and presentation Applicability Editorial independence AGREE II criteria used Figure 1: Cancer Guidelines workflow To be included in this database, clinical practice guidelines are first evaluated using the eight items in the Rigour of Development domain of AGREE II (see Figure 1: Cancer Guidelines workflow). Guidelines that score 60 per cent or above in the domain are then assessed by two independent reviewers using the full AGREE II Instrument. Guidelines that score between 50 and 60 per cent receive additional review to confirm that the 60 per cent cut-off is appropriate, and doesn’t unfairly exclude guidelines of reasonable quality. To receive high scores, a guideline must show a clear link between the proper collection of research evidence and its use. The guideline must also have an appropriate and representative panel. The panel’s process must be transparent and reproducible to create and implement the guideline’s recommendations. Higher AGREE II scores indicate that a guideline’s reporting quality is higher. Such scores also indicate that guideline developers used an evidence-based approach to reach their recommendations. AGREE II does not generate a global aggregate score. Ensuring reliable AGREE II scores All reviews are conducted by experienced guideline appraisers that have undergone rigorous training on the AGREE II Instrument. Agreement between reviewers is calculated based on the standard deviation of the reviewers’ scores within a domain. If a guideline is flagged as having disagreement, a third reviewer is assigned to complete an independent AGREE II assessment. Then, agreement is re-calculated across all three reviewers. If the disagreement isn’t satisfied, reviewers look at the guideline and resolve discrepancies by consensus. Featured Guidelines Developer organization Publication year AGREE II score Unavailable View guideline Developer organization Publication year AGREE II score Unavailable View guideline Developer organization Publication year AGREE II score Unavailable View guideline Developer organization Publication year AGREE II score Unavailable View guideline
