Impact of Filters by Database and Language on Quality and Volume of Clinical Practice Guidelines for the Supportive Care of Children with Cancer
Asher Hancock, Brandon Fickling, Tea Reljic, Sergio Licona, Vivian Moreno Berrio, Ambuj Kumar, Sheena MukkadaAbstract
Background
Clinical practice guidelines (CPGs) are intended to promote the delivery of evidence-based care and optimize the use of limited resources in treating common conditions. However, they are not always developed using evidence-based methods. Using febrile neutropenia (FN), a common and costly complication of cancer-directed therapy, as an index condition, we assessed the quality of CPGs identified through a systematic search. Given our interest in developing recommendations for low- and middle-income countries (LMICs), we assessed the effect of altering the number of databases and language screening criteria on the quantity and quality of FN CPGs.
Methods
Our approach consisted of a systematic search, guideline appraisal, and data extraction. Any evidence-based CPGs published in the last 10 years addressing the management of febrile neutropenia (FN) in children was eligible for inclusion. We searched PubMed, Embase, and Web of Science databases to identify eligible FN CPGs. The methodological quality of English and non-English FN CPGs was assessed using the AGREE-II instrument. The comparison of methodological quality between English and non-English CPGs was performed using the Mann-Whitney U test.
Results
Fourteen CPGs met inclusion criteria. Ten were in English and four (3 Spanish, 1 German) were in non-English languages. The median overall score for English language CPGs was 85.7% (range: 42.9-100%) versus 71.4% (range: 71.4-85.7%) for non-English. Table 1 highlights the scores across each domain using the AGREE-II instrument. Additionally, each database had at least one unique guideline.
Conclusions
The clinical practice recommendations search should involve searching multiple databases without any language filters as limited searches impact the quantity and quality of CPGs identified. The English language CPGs compared with non-English consistently scored higher across all AGREE-2 domains. There was no statistically significant difference in terms of methodological quality between the English and non-English FN CPGs across all AGREE-2 domains except for scope and purpose. The findings demonstrate the need to include non-English guidelines when creating resource adapted recommendations to support the treatment of children with cancer in LMICs.