Quality of clinical practice guidelines in dermatological oncology.
BACKGROUND
Clinical practice guidelines are increasingly used. To determine the quality of guidelines the Appraisal of Guidelines and Research and Evaluation (AGREE) instrument was developed and introduced in 2001. The AGREE instrument consists of 23 criteria, grouped in six domains.


OBJECTIVE
Assessment of quality of evidence-based guidelines in dermatological oncological care according to the AGREE instrument.


METHODS
We searched MEDLINE, PubMed, EMBASE and Cochrane literature and relevant websites of guidelines development programmes and the national dermatological society to identify evidence-based dermatological guidelines especially in the treatment of to basal cell carcinoma, squamous cell carcinoma and melanoma. Twenty guidelines, published between 1990 and 2005, were appraised according to the AGREE instrument by three authors. Standardized domain scores were calculated as advised by AGREE. We compared guidelines published before 2002 with those published later.


RESULTS
Domain scores in the domains Scope & Purpose and Clarity were scored best. Applicability and Editorial Independence were scored worst (see Table 1). In time a weak trend towards better guidelines was seen. This trend can be attributed to better scores in the domains Search Strategy and Level of Evidence which are closely related to evidence-based medicine. The increase in score is due to more explicitly mentioning the search strategy, possible conflict of interest and involvement of different specialties in development of the guideline. Using the Mann-Whitney test to compare guidelines published before the AGREE and afterwards only a statistically significant better score was found for the domain Clarity (P < 0.05; Table 2).


CONCLUSIONS
Guidelines in dermatological oncological care are of reasonable quality according to the AGREE instrument. The domains in the AGREE instrument concern especially the methods of development of guidelines. The score according to AGREE can be improved by explicitly mentioning the different items. As clinical guidelines are regarded to be an important instrument to improve quality of care, improvements are needed.
de Haas
E R M
ER
Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands. e.r.m.dehaas@erasmusmc.nl
de Vijlder
H C
HC
van Reesema
W Siewertz
WS
van Everdingen
J J E
JJ
Neumann
H A M
HA
D003880:Dermatology / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011786:Quality Control; D018709:Statistics, Nonparametric