Clinical Practice Guidelines in the Management of Generalized Cancer Pain: A Systematic Evaluation Using the AGREE II Instrument

Abstract

Abstract Purpose While several clinical practice guidelines (CPGs) exist to guide clinical decision-making in patients presenting with generalized cancer pain, to date there has been no comprehensive review of their methodological rigor and quality. Our aim was to address this deficiency by using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Methods A systematic literature search to identify relevant CPGs was performed over the following databases from inception to March 3, 2021: Embase, MEDLINE via PubMed, and Scopus. Four authors (FR, AR, JN, and JH) independently performed assessments and evaluations of the selected CPGs using the AGREE II instrument. Scaled domain percentage scores were calculated and 60% was defined as the satisfactory quality threshold. Intraclass correlation coefficients (ICCs) were also calculated to assess interrater reliability and consistency. Results 12 guidelines were selected for inclusion. Two guidelines were classified high quality, three guidelines were classified as average quality, and seven were classified as low quality. Domains 4 (clarity of presentation) and 1 (scope and purpose) received the highest mean scores (82.41% ± 18.20% and 56.48% ± 30.59%), while domains 5 (applicability) and 2 (stakeholder involvement) received the lowest (44.53% ± 26.61% and 36.81% ± 21.24%). ICC statistical analysis showed high consistency between reviewers (range 0.85–0.98). Conclusion Based on the AGREE II instrument, the majority of CPGs for generalized cancer pain were of low or average quality. Future guidelines for generalized cancer pain can be improved by better defining stakeholder involvement, rigor of development, applicability, and editorial independence during development.