全球结直肠癌筛查指南的质量评价
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摘要
目的:对全球范围内现有结直肠癌筛查指南进行系统梳理和质量评价。方法:采用系统综述的方法,对CNKI、万方、VIP、Sino Med、Pub Med、Embase、Web of Science等中、英文数据库进行系统检索,检索时间截至2018年6月20日,同时检索了指南制订机构网站和主要搜索引擎,检索时间为2018年8月3日。对所有文献采用双人独立筛选、信息提取,由4名经培训的评价者使用AGREEⅡ(Appraisal of Guidelines for Research&Evaluation)工具对纳入指南进行质量评价。结果:共纳入符合标准的结直肠癌筛查指南46部,发布年代为1994—2018年,来自10个国家,5个地区。AGREEⅡ工具的评价结果显示,各指南质量在领域1(范围及目的)与领域4(表述清晰性)方面较高,在领域2(参与人员)方面中等,在领域3(过程严谨性)、领域5(适用性)和领域6(独立性)差异较大,循证指南(基于WHO指南制定标准进行定义)的质量总体优于一般指南。我国大陆现有结直肠癌筛查指南5部,均非循证指南,质量总体较低。结论:全球范围内结直肠癌筛查指南总体呈现数量多、质量较低的现状,中国大陆现有指南均不是循证指南,因此需要根据我国国情,建立高质量的结直肠筛查指南,为公共卫生实践提供可行的指导。
Objective: To systematically review and assess the quality of guidelines on colorectal cancer screening worldwide to provide guidance for the development of high-quality colorectal cancer screening guidelines in mainland China. Methods: CNKI,WanFang Data,VIP,SinoMed,PubMed,Embase,and Web of Science were systematically searched to identify guidelines on colorectal cancer screening from inception to Jun. 20 th,2018,and so were some websites and major search engines about the development of the guidelines from the existing literature( search date: Aug. 3 rd,2018). Two experienced reviewers independently examined these abstracts and then extracted information,and the Appraisal of Guidelines for Research and Evaluation Ⅱ( AGREE Ⅱ) were used to evaluate the methodological quality of these guidelines by four well trained reviewers. Results: In this study,46 guidelines published from1994 to 2018 were finally included in our analysis from 10 countries and 5 regions,among which 5 were from mainland China. The quality of these guidelines was relatively high in domain 1( scope and purpose) and domain 4( clarity of presentation),and medium in domain 2( stakeholder involvement).While in the other three domains( domain 3: rigour of development; domain 5: applicability; domain 6:editorial independence),the results were quite different among these guidelines. The quality of evidencebased guidelines( defined by the criteria based on World Health Organization guideline development handbook) was generally higher than that of the common guidelines. Existing guidelines from mainland China were not evidence-based guidelines,which were of low quality. Conclusion: The colorectal cancer screening guidelines all over the world are generally large in number,low in quality,different in statements,and so are the guidelines in China. There are no evidence-based guidelines in mainland China,which cannot provide effective guidance for colorectal cancer screening,so we need to pay more attention to the establishment of guidelines with high quality and high credibility for colorectal cancer screening as well as for cancer screening based on the national condition,in order to provide reasonable guidance for practice in public health and improve the health conditions in our society.
Objective: To systematically review and assess the quality of guidelines on colorectal cancer screening worldwide to provide guidance for the development of high-quality colorectal cancer screening guidelines in mainland China. Methods: CNKI,WanFang Data,VIP,SinoMed,PubMed,Embase,and Web of Science were systematically searched to identify guidelines on colorectal cancer screening from inception to Jun. 20 th,2018,and so were some websites and major search engines about the development of the guidelines from the existing literature( search date: Aug. 3 rd,2018). Two experienced reviewers independently examined these abstracts and then extracted information,and the Appraisal of Guidelines for Research and Evaluation Ⅱ( AGREE Ⅱ) were used to evaluate the methodological quality of these guidelines by four well trained reviewers. Results: In this study,46 guidelines published from1994 to 2018 were finally included in our analysis from 10 countries and 5 regions,among which 5 were from mainland China. The quality of these guidelines was relatively high in domain 1( scope and purpose) and domain 4( clarity of presentation),and medium in domain 2( stakeholder involvement).While in the other three domains( domain 3: rigour of development; domain 5: applicability; domain 6:editorial independence),the results were quite different among these guidelines. The quality of evidencebased guidelines( defined by the criteria based on World Health Organization guideline development handbook) was generally higher than that of the common guidelines. Existing guidelines from mainland China were not evidence-based guidelines,which were of low quality. Conclusion: The colorectal cancer screening guidelines all over the world are generally large in number,low in quality,different in statements,and so are the guidelines in China. There are no evidence-based guidelines in mainland China,which cannot provide effective guidance for colorectal cancer screening,so we need to pay more attention to the establishment of guidelines with high quality and high credibility for colorectal cancer screening as well as for cancer screening based on the national condition,in order to provide reasonable guidance for practice in public health and improve the health conditions in our society.
引文
[1] World Health Organization. Cancer[EB/OL].[2018/12/13]https://www. who. int/en/news-room/fact-sheets/detail/cancer.
[2] Chen WQ,Zeng HM,Zheng RS,et al. Cancer incidence and mortality in china,2007[J]. Chin J Cancer Res,2012,24(1):1-8.
[3]郑荣寿,张思维,吴良有,等.中国肿瘤登记地区2008年恶性肿瘤发病和死亡分析[J].中国肿瘤,2012,21(1):1-12.
[4]陈万青,张思维,郑荣寿,等.中国2009年恶性肿瘤发病和死亡分析[J].中国肿瘤,2013,22(1):2-12.
[5]陈万青,张思维,曾红梅,等.中国2010年恶性肿瘤发病与死亡[J].中国肿瘤,2014,23(1):1-10.
[6]陈万青,郑荣寿,曾红梅,等. 2011年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2015,24(1):1-10.
[7]陈万青,郑荣寿,张思维,等. 2012年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2016,25(1):1-8.
[8]陈万青,郑荣寿,张思维,等. 2013年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2017,26(1):1-7.
[9] Institute of Medicine(US). Committee to Advise the Public Health Service on Clinical Practice Guidelines. Field MJ,Lohr KN. Clinical practice guidelines:directions for a new program[M]. Washington,DC:National Academies Press,1990.
[10] Institute of Medicine(US). Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Graham R,Mancher M,Wolman D,et al. Clinical practice guidelines we can trust[M]. Washington,DC:National Academies Press,2011.
[11] Shekelle PG. Clinical practice guidelines:what’s next?[J].JAMA,2018,320(8):757-758.
[12]胡晶,詹思延.中国临床实践指南制定的现状与建议[J].中国循证心血管医学杂志,2013,5(3):217-218.
[13]林夏,杨克虎,陈耀龙,等.中国临床实践指南的现状与思考[J].中国循证医学杂志,2017,17(5):497-500.
[14]李江,苏凯,李放,等.肺癌筛查领域指南方法学质量的系统评价[J].中国肺癌杂志,2016,19(10):692-699.
[15]李江,唐威,李霓,等.乳腺癌筛查指南方法学质量和报告质量的系统评价[J].中国循证医学杂志,2018,18(6):629-636.
[16] Ebell MH,Thai TN,Royalty KJ. Cancer screening recommendations:an international comparison of high income countries[J].Public Health Rev,2018,39(1):7.
[17]胡晶,陈茹,谢雁鸣,等.科学和规范的改编临床实践指南[J].中国循证儿科杂志,2012,7(3):226-230.
[18]张珊瑚.产后出血临床指南的循证评价及实用优化研究[D].甘肃:兰州大学,2014.
[19] WHO. WHO handbook for guideline development[M]. 2nd ed.Geneva:World Health Organization,2014.
[20] Brouwers MC,Kho ME,Browman GP,et al. AGREEⅡ:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med,2010,51(5):421-424.
[21]韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.
[22]乔舰.组内相关系数的理论基础及建模应用[J].统计与信息论坛,2016,31(11):44-48.
[23] Bacchus CM,Dunfield L,Gorber SC,et al. Recommendations on screening for colorectal cancer in primary care[J]. CMAJ,2016,188(5):340-348.
[24] Bibbins-Domingo K,Grossman DC,Curry SJ,et al. Screening for colorectal cancer:US preventive services task force recommendation statement[J]. JAMA,2016,315(23):2564-2575.
[25]王振军,付李缘.大肠癌筛查共识与争议[J].临床外科杂志,2018,26(10):721-723.
[26]陈宏达,卢明,代敏.我国结直肠癌人群筛查参与率现状及影响因素探讨[J].华西医学,2018,33(12):1-5.
[27] Leddin D,Lieberman DA,Tse F,et al. Clinical practice guideline on screening for colorectal cancer in individuals with a family history of nonhereditary colorectal cancer or adenoma:The Canadian Association of Gastroenterology Banff Consensus[J]. Gastroenterology,2018,155(5):1325-1347.
[28] Sung JJ,Ng SC,Chan FK,et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening[J]. Gut,2015,64(1):121-132.
[29] Lee BI,Hong SP,Kim SE,et al. Korean guidelines for colorectal cancer screening and polyp detection[J]. Clin Endosc,2012,45(1):25-43.
[2] Chen WQ,Zeng HM,Zheng RS,et al. Cancer incidence and mortality in china,2007[J]. Chin J Cancer Res,2012,24(1):1-8.
[3]郑荣寿,张思维,吴良有,等.中国肿瘤登记地区2008年恶性肿瘤发病和死亡分析[J].中国肿瘤,2012,21(1):1-12.
[4]陈万青,张思维,郑荣寿,等.中国2009年恶性肿瘤发病和死亡分析[J].中国肿瘤,2013,22(1):2-12.
[5]陈万青,张思维,曾红梅,等.中国2010年恶性肿瘤发病与死亡[J].中国肿瘤,2014,23(1):1-10.
[6]陈万青,郑荣寿,曾红梅,等. 2011年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2015,24(1):1-10.
[7]陈万青,郑荣寿,张思维,等. 2012年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2016,25(1):1-8.
[8]陈万青,郑荣寿,张思维,等. 2013年中国恶性肿瘤发病和死亡分析[J].中国肿瘤,2017,26(1):1-7.
[9] Institute of Medicine(US). Committee to Advise the Public Health Service on Clinical Practice Guidelines. Field MJ,Lohr KN. Clinical practice guidelines:directions for a new program[M]. Washington,DC:National Academies Press,1990.
[10] Institute of Medicine(US). Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Graham R,Mancher M,Wolman D,et al. Clinical practice guidelines we can trust[M]. Washington,DC:National Academies Press,2011.
[11] Shekelle PG. Clinical practice guidelines:what’s next?[J].JAMA,2018,320(8):757-758.
[12]胡晶,詹思延.中国临床实践指南制定的现状与建议[J].中国循证心血管医学杂志,2013,5(3):217-218.
[13]林夏,杨克虎,陈耀龙,等.中国临床实践指南的现状与思考[J].中国循证医学杂志,2017,17(5):497-500.
[14]李江,苏凯,李放,等.肺癌筛查领域指南方法学质量的系统评价[J].中国肺癌杂志,2016,19(10):692-699.
[15]李江,唐威,李霓,等.乳腺癌筛查指南方法学质量和报告质量的系统评价[J].中国循证医学杂志,2018,18(6):629-636.
[16] Ebell MH,Thai TN,Royalty KJ. Cancer screening recommendations:an international comparison of high income countries[J].Public Health Rev,2018,39(1):7.
[17]胡晶,陈茹,谢雁鸣,等.科学和规范的改编临床实践指南[J].中国循证儿科杂志,2012,7(3):226-230.
[18]张珊瑚.产后出血临床指南的循证评价及实用优化研究[D].甘肃:兰州大学,2014.
[19] WHO. WHO handbook for guideline development[M]. 2nd ed.Geneva:World Health Organization,2014.
[20] Brouwers MC,Kho ME,Browman GP,et al. AGREEⅡ:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med,2010,51(5):421-424.
[21]韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.
[22]乔舰.组内相关系数的理论基础及建模应用[J].统计与信息论坛,2016,31(11):44-48.
[23] Bacchus CM,Dunfield L,Gorber SC,et al. Recommendations on screening for colorectal cancer in primary care[J]. CMAJ,2016,188(5):340-348.
[24] Bibbins-Domingo K,Grossman DC,Curry SJ,et al. Screening for colorectal cancer:US preventive services task force recommendation statement[J]. JAMA,2016,315(23):2564-2575.
[25]王振军,付李缘.大肠癌筛查共识与争议[J].临床外科杂志,2018,26(10):721-723.
[26]陈宏达,卢明,代敏.我国结直肠癌人群筛查参与率现状及影响因素探讨[J].华西医学,2018,33(12):1-5.
[27] Leddin D,Lieberman DA,Tse F,et al. Clinical practice guideline on screening for colorectal cancer in individuals with a family history of nonhereditary colorectal cancer or adenoma:The Canadian Association of Gastroenterology Banff Consensus[J]. Gastroenterology,2018,155(5):1325-1347.
[28] Sung JJ,Ng SC,Chan FK,et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening[J]. Gut,2015,64(1):121-132.
[29] Lee BI,Hong SP,Kim SE,et al. Korean guidelines for colorectal cancer screening and polyp detection[J]. Clin Endosc,2012,45(1):25-43.