Advertisement

Analytical frameworks in colorectal cancer guidelines: development of methods for systematic reviews, their application and practical guidance for their use

  • Samer G. Karam
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
    Search for articles by this author
  • Andrea J. Darzi
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
    Search for articles by this author
  • Antonio Bognanni
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
    Search for articles by this author
  • Rami Z. Morsi
    Affiliations
    Department of Neurology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA
    Search for articles by this author
  • Elie E. Tannous
    Affiliations
    Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
    Search for articles by this author
  • Rana Charide
    Affiliations
    AUB GRADE Center, Clinical Research Institute, American University of Beirut, Riad El Solh, Beirut 1107-2020, Lebanon
    Search for articles by this author
  • Se-In Choe
    Affiliations
    Department of Surgery, McMaster University, Hamilton, Canada
    Search for articles by this author
  • Rosa Stalteri
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
    Search for articles by this author
  • Yung Lee
    Affiliations
    Department of Surgery, McMaster University, Hamilton, Canada
    Search for articles by this author
  • Thomas Piggott
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
    Search for articles by this author
  • Laura Jewell
    Affiliations
    Memorial University of Newfoundland, Discipline of Family Medicine, Happy Valley-Goose Bay, Canada
    Search for articles by this author
  • Finn Schünemann
    Affiliations
    Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Breisacher Str. 86, Freiburg 79110, Germany
    Search for articles by this author
  • Miranda Langendam
    Affiliations
    Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health institute, University of Amsterdam, Amsterdam, the Netherlands
    Search for articles by this author
  • Elena Parmelli
    Affiliations
    European Commission, Joint Research Centre (JRC), Ispra, Italy
    Search for articles by this author
  • Zuleika Saz-Parkinson
    Affiliations
    European Commission, Joint Research Centre (JRC), Ispra, Italy
    Search for articles by this author
  • Annett Roi
    Affiliations
    European Commission, Joint Research Centre (JRC), Ispra, Italy
    Search for articles by this author
  • Nadia Vilahur
    Affiliations
    European Commission, Joint Research Centre (JRC), Ispra, Italy
    Search for articles by this author
  • Yasaman Vali
    Affiliations
    Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health institute, University of Amsterdam, Amsterdam, the Netherlands
    Search for articles by this author
  • Siw Waffenschmidt
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Institute for Quality and Efficiency in Health Care, Cologne, Germany
    Search for articles by this author
  • Douglas K. Owens
    Affiliations
    Stanford Health Policy, Department of Medicine and Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
    Search for articles by this author
  • Grigorios I. Leontiadis
    Affiliations
    Department of Medicine, McMaster University, Hamilton, Ontario, Canada
    Search for articles by this author
  • Paul Moayyedi
    Affiliations
    Department of Medicine, McMaster University, Hamilton, Ontario, Canada
    Search for articles by this author
  • Jan L. Brozek
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Department of Medicine, McMaster University, Hamilton, Ontario, Canada
    Search for articles by this author
  • Holger J. Schünemann
    Correspondence
    Corresponding author. Department of Health Research Methods, Evidence and Impact, McMaster University, HSC-2C, 1280 Main St West, Hamilton, Ontario L8N 3Z5, Canada. Tel.: +1 905 525 9140 x 24931; fax: +1 905 522 9507.
    Affiliations
    Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada

    Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada

    Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Department of Biomedical Sciences Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milano, Italy
    Search for articles by this author

      Abstract

      Objectives

      Analytical frameworks are graphical representation of the key questions answered by a systematic review and can support the development of guideline recommendations. Our objectives were to a) conduct a systematic review to identify, describe and compare all analytical frameworks published as part of a systematic and guideline development process related to colorectal cancer (CRC), and b) to use this case study to develop guidance on how to conduct systematic reviews of analytical frameworks.

      Methods

      We developed a search strategy to identify eligible studies in Medline and Embase from 1996 until December 2020. We also manually searched guideline databases and websites to identify all guidelines and systematic reviews in CRC that used an analytical framework. We assessed the quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool. The systematic review was registered in International Prospective Register of Systematic Reviews, registration CRD42020172117.

      Results

      We screened 34,505 records and identified 1,166 guidelines and 3,127 systematic reviews on CRC of which five met our inclusion criteria. These five publications included four analytical frameworks in colorectal cancer (one update). We also describe our methodological approach to systematic reviews for analytical frameworks and underlying concepts for developing analytical framework using a bottom-up or top-down approach.

      Conclusion

      Few guidelines and systematic reviews are utilizing analytical frameworks in the development of recommendations. Development of analytical frameworks should begin with a systematic search for existing analytical frameworks and follow a structured conceptual approach for their development to support guideline recommendations. Our methods may be helpful in achieving these objectives.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Graham R.
        • Mancher M.
        • Guidelines IoMCoSfDTCP
        Clinical practice guidelines we can trust.
        National Academies Press, Washington, DC2011
        • Woolf S.H.
        Evidence-based medicine and practice guidelines: an overview.
        Cancer Control. 2000; 7: 362-367
        • Oxman A.D.
        • Fretheim A.
        • Schünemann H.J.
        Improving the use of research evidence in guideline development: introduction.
        Health Res Pol Syst. 2006; 4: 1-4
        • Schünemann H.J.
        • Fretheim A.
        • Oxman A.D.
        Improving the use of research evidence in guideline development: 1. guidelines for guidelines.
        Health Res Policy Syst. 2006; 4: 1-6
        • Greenfield S.
        • Mancher M.
        • Wolman D.M.
        • Graham R.
        • Services B.H.C.
        • et al.
        • Guidelines CSDTCP
        Clinical practice guidelines we can trust.
        National Academies Press, Washington, DC2011
        • Schünemann H.J.
        • Wiercioch W.
        • Etxeandia I.
        • Falavigna M.
        • Santesso N.
        • Mustafa R.
        • et al.
        Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.
        CMAJ. 2014; 186: E123-E142
        • Wiercioch W.
        • Akl E.A.
        • Santesso N.
        • Zhang Y.
        • Morgan R.L.
        • Yepes-Nunez J.J.
        • et al.
        Assessing the process and outcome of the development of practice guidelines and recommendations: PANELVIEW instrument development.
        CMAJ. 2020; 192: E1138-E1145
        • Harris R.P.
        • Helfand M.
        • Woolf S.H.
        • Lohr K.N.
        • Mulrow C.D.
        • Teutsch S.M.
        • et al.
        Current methods of the US preventive services task force: a review of the process.
        Am J Prev Med. 2001; 20: 21-35
        • Mulrow C.
        • Langhorne P.
        • Grimshaw J.
        Integrating heterogeneous pieces of evidence in systematic reviews. Systematic reviews: synthesis of best evidence for health care decisions.
        American College of Physicians, Philadelphia1998: 103-112
        • Woolf S.
        • Schünemann H.J.
        • Eccles M.P.
        • Grimshaw J.M.
        • Shekelle P.
        Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations.
        Implement Sci. 2012; 7: 1-12
        • Battista R.N.
        • Fletcher S.
        Making recommendations on preventive practices: methodological issues.
        Am J Prev Med. 1988; 4: 53-76
        • Blalock J.
        Causal models in the social sciences.
        Routledge, New York, NY2017
        • Howard R.A.
        Readings on the principles and applications of decision analysis.
        Strategic Decisions Group, Menlo Park, CA1983
        • Woolf S.H.
        Woolf, S. H. (1991). Interim manual for clinical practice guideline development. Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Service (No. 91).
        AHCPR, Rockville, MD1991
        • US Preventive Services Task Force
        USPSTF procedure manual US Preventive Services Task Force.
        (Available at)
        • Canadian Task Force on Preventive Health C
        Recommendations on screening for colorectal cancer in primary care.
        CMAJ. 2016; 188: 340-348
        • Shamseer L.
        • Moher D.
        • Clarke M.
        • Ghersi D.
        • Liberati A.
        • Petticrew M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.
        BMJ. 2015; 349: g7647
        • Higgins J.P.T
        • Green S
        Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]..
        The Cochrane Library, 2006 (Available at)
        • Johnston A.
        • Kelly S.E.
        • Hsieh S.-C.
        • Skidmore B.
        • Wells G.A.
        Systematic reviews of clinical practice guidelines: a methodological guide.
        J Clin Epidemiol. 2019; 108: 64-76
        • Woolf S.H.
        • DiGuiseppi C.G.
        • Atkins D.
        • Kamerow D.B.
        Developing evidence-based clinical practice guidelines: lessons learned by the US Preventive Services Task Force.
        Annu Rev Public Health. 1996; 17: 511-538
        • Brouwers M.C.
        • Kho M.E.
        • Browman G.P.
        • Burgers J.S.
        • Cluzeau F.
        • Feder G.
        • et al.
        Agree II: advancing guideline development, reporting and evaluation in health care.
        CMAJ. 2010; 182: E839-E842
        • Lin J.S.
        • Piper M.A.
        • Perdue L.A.
        • Rutter C.M.
        • Webber E.M.
        • O’connor E.
        • et al.
        Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force.
        JAMA. 2016; 315: 2576-2594
        • Bibbins-Domingo K.
        • Grossman D.C.
        • Curry S.J.
        • Davidson K.W.
        • Epling J.W.
        • Garcia F.A.R.
        • et al.
        Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2016; 315: 2564-2575
        • Sohn D.K.
        • Kim M.J.
        • Park Y.
        • Suh M.
        • Shin A.
        • Lee H.Y.
        • et al.
        The Korean guideline for colorectal cancer screening. [Korean].
        J Korean Med Assoc. 2015; 58: 420-432
        • Bibbins-Domingo K.
        • Grossman D.C.
        • Curry S.J.
        • Davidson K.W.
        • Epling J.W.
        • Garcia F.A.R.
        • et al.
        Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2016; 164: 836-845
        • Whitlock E.P.
        • Lin J.S.
        • Liles E.
        • Beil T.L.
        • Fu R.
        Screening for colorectal cancer: a targeted, updated systematic review for the US Preventive Services Task Force.
        Ann Intern Med. 2008; 149: 638-658
        • Davidson K.W.
        • Barry M.J.
        • Mangione C.M.
        • Cabana M.
        • Caughey A.B.
        • Davis E.M.
        • et al.
        Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.
        JAMA. 2021; 325: 1965-1977
        • Chubak J.
        • Kamineni A.
        • Buist D.S.
        • Anderson M.L.
        • Whitlock E.P.
        Aspirin use for the prevention of colorectal cancer: an updated systematic evidence review for the US Preventive Services Task Force..
        Evidence Syntheses. No.133. Agency for Healthcare Research and Quality, Rockville MD2015 (Available at)
        • Lin J.S.
        • Piper M.A.
        • Perdue L.A.
        • Rutter C.
        • Webber E.M.
        • O’Connor E.
        • et al.
        Screening for colorectal cancer: a systematic review for the US Preventive Services Task Force [Internet]..
        Evidence Syntheses. No.135,. Agency for Healthcare Research and Quality, Rockville MD2016 (Available at)
        • Lin J.S.
        • Piper M.A.
        • Perdue L.A.
        • Rutter C.M.
        • Webber E.M.
        • O'Connor E.
        • et al.
        Screening for colorectal cancer: updated evidence report and systematic review for the US preventive services task force.
        JAMA. 2016; 315: 2576-2594
        • Canadian Task Force on Preventive Health Care
        Canadian Task Force on Preventive Health Care Procedure Manual 2014.
        (Available at)
        • Wolffe T.A.
        • Whaley P.
        • Halsall C.
        • Rooney A.A.
        • Walker V.R.
        Systematic evidence maps as a novel tool to support evidence-based decision-making in chemicals policy and risk management.
        Environ Int. 2019; 130: 104871