Appropriateness of colorectal cancer screening: appraisal of evidence by experts.
OBJECTIVE
. To evaluate how the level of evidence perceived by an international panel of experts was concordant with the level of evidence found in the literature, to compare experts perceived level of evidence to their appropriateness scores, and to compare appropriateness criteria for colonoscopy between experts and an evidence-based approach.


METHODS
Comparison of expert panel opinions and systematic literature review regarding the level of evidence and appropriateness of colonoscopy indications.


METHODS
European Panel on the Appropriateness of Gastrointestinal Endoscopy multidisciplinary experts from 14 European countries.


METHODS
Concordance and weighted kappa coefficient between level of evidence as perceived by the experts' and that found in the literature, and between panel- and literature-based appropriateness categories.


RESULTS
Experts overestimated the level of published evidence of 57 indications. Concordance between the level of evidence perceived by the experts and the actual level of evidence found in the literature was 36% (weighted kappa 0.18). Indications for colonoscopy were reported to be appropriate, uncertain, and inappropriate by the experts in 54, 19, and 27% of the cases, and by the literature in 37, 46, and 17% of the cases. A 46% agreement (weighted kappa 0.29) was found between literature-based and experts' appropriateness criteria.


CONCLUSIONS
Experts often overestimated the level of evidence on which they based their decisions. However, rarely did the experts' judgement completely disagree with the literature, although concordance between panel- and literature-based appropriateness was only fair. A more explicit discussion of existing evidence should be undertaken with the experts before they evaluate appropriateness criteria.
Bridevaux
Isabelle Peytremann
IP
Gastroenterology Department, University of Basle, Switzerland. isabell.peytremann-bridevaux@hospvd.ch
Silaghi
Anne-Melody
AM
Vader
John-Paul
JP
Froehlich
Florian
F
Gonvers
Jean-Jacques
JJ
Burnand
Bernard
B
D015179:Colorectal Neoplasms / Q000175:diagnosis*; D032921:Consensus; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005060:Europe; D019317:Evidence-Based Medicine; D006801:Humans; D038622:Internationality; D008403:Mass Screening / Q000592:standards*; D017410:Practice Guidelines as Topic