Guidelines for the use of survivorship care plans: a systematic quality appraisal using the AGREE II instrument.
BACKGROUND
Survivorship care plans (SCPs) are written treatment summaries and follow-up care plans that are intended to facilitate communication and coordination of care among survivors, cancer care providers, and primary care providers. A growing number of guidelines for the use of SCPs exist, yet SCP use in the United States remains limited. Limited use of SCPs may be due to poor quality of these guidelines. The purpose of the study was to evaluate the quality of guidelines for SCP use, tools that are intended to promote evidence-based medicine.


METHODS
We conducted a comprehensive search of the literature using MEDLINE/PubMed, EMBASE (Excerpta Medica Database), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) published through April 2014, in addition to grey literature sources and bibliographic and expert reviews. Guideline quality was assessed using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation, 2nd edition), a tool developed by an international group of scientists to advance the quality of clinical practice guidelines. To promote consistency with extant studies using the AGREE II instrument and to clearly and unambiguously identify potentially useful guidelines for SCP use, we also summarized AGREE II scores by strongly recommending, recommending, or not recommending the guidelines that we evaluated.


RESULTS
Of 128 documents screened, we included 16 guidelines for evaluation. We did not strongly recommend any of the 16 guidelines that we evaluated; we recommended 5 and we did not recommend 11. Overall, guidelines scored highest on clarity of presentation (i.e., guideline language, structure, and format): Guidelines were generally unambiguous in their recommendations that SCPs should be used. Guidelines scored lowest on applicability (i.e., barriers and facilitators to implementation, implementation strategies, and resource implications of applying the guideline): Few guidelines discussed facilitators and barriers to guideline application; advice and tools for implementing guidelines were vague; and none explicitly discussed resource implications of implementing the guidelines.


CONCLUSIONS
Guidelines often advocated survivorship care plan use without justification or suggestions for implementation. Improved guideline quality may promote survivorship care plan use.
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. birken@unc.edu.
Sarah A
SA
Birken
Department of Health Policy and Management, University of Kansas School of Medicine, Mail Stop 3044, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA. sellis4@kumc.edu.
Shellie D
SD
Ellis
Health Sciences Library, The University of North Carolina at Chapel Hill, 335 S. Columbia Street, Chapel Hill, NC, 27599-7585, USA. jennifer_walker@unc.edu.
Jennifer S
JS
Walker
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. dmartin@email.unc.edu.
Lisa D
LD
DiMartino
Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. dkcheck@live.unc.edu.
Devon K
DK
Check
School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA. gerstel@email.unc.edu.
Adrian A
AA
Gerstel
School of Nursing, University of North Carolina at Chapel Hill, 2800 Carrington Hall CB# 7460, Chapel Hill, NC, 27599, USA. dmayer@unc.edu.
Deborah K
DK
Mayer
D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010347:Patient Care Planning / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care; D017741:Survivors