Methods of the ECIBC Platform of Guidelines for breast cancer care
A systematic search of breast cancer guidelines appraised and scored, according with the AGREE II tool
The Guidelines Platform hosts existing high-quality guidelines, developed by entities external to the European Commission. They cover all breast cancer care processes, excluding screening and diagnosis. Guidelines dealing with screening and diagnosis are not included in the Platform, but might be used to underpin the European QA Scheme.
The objectives of the Guidelines Platform are:
- to build a public platform of evidence-based guidelines for breast cancer (This involves collecting existing trustworthy evidence-based guidelines for breast cancer services along the pathway at Figure 1, focusing on, but not limited to, the European context.);
- to extract, from the collected guidelines, evidence-based recommendations mainly focussed on breast cancer care (and to potentially underpin, via those recommendations, the European QA scheme requirements).
The Guidelines Platform responds to the need of collecting high-quality evidence-based guidelines in a single place and to make them easy to navigate for interested users. It contains those breast cancer guidelines that are rigorously developed and not older than ten years. The AGREE II tool has been chosen as a validated tool to evaluate the quality of the guidelines to be included in the Guidelines Platform.
1. Workflow to populate the Guidelines Platform
The following steps have been taken for guidelines to be included in the platform:
- A systematic search and an open call for guidelines contributed to the identification and collection of breast cancer guidelines. For more details see Report on The ECIBC Guidelines Platform for all breast care processes.
- The Commission awarded a contract to Iberoamerican Cochrane Centre (CCIb) to appraise and score, according with the AGREE II tool the breast cancer guidelines collected.
- The Commission contracted two distinct evaluators (University of Warwick and GIMBE Foundation) to run independent and parallel assessments of the usability of qualitative and quantitative AGREE II domains' thresholds for considering guidelines as reliable in national and international contexts.
- The guidelines have to be trustworthy (see definition in full document or in the glossary) and to fulfil the requirements regarding the thresholds.
- A contact person representing the developer of the guideline should be identified.
2. Methodology to establish the final desirable quality thresholds in order to include the guidelines on the platform
The following scenarios might arise from the results of the two evaluators:
- neither evaluator can propose any (quantitative) threshold (In this case no threshold will be required – all trustworthy guidelines will be included on the Platform.);
- both evaluators propose thresholds for the same domains/criteria and also the same values for the thresholds (In this case the collected trustworthy documents should have a score equal or above the thresholds in order to be included on the Platform.);
- one evaluator proposes a threshold and the other doesn’t (In this case, the threshold indicated by the evaluator will be used along what was described as scenario B.);
- both evaluators propose thresholds for the same domains, but with different values. (In this case the thresholds will be obtained from the simple average of the two proposed ones and only guidelines scoring above the simple average threshold are included in the Platform.);
- the evaluators provide thresholds for different domains. (In this case all the thresholds will be used along what was described as scenario B. E.g. evaluator A establishes that for domain X a score above n should be used and evaluator B establishes that for domain Y a score above m should be used. In this case, a guideline should score equal or above n for the domain X and equal or above m for domain Y.)
3. From guidelines to recommendations
For the guidelines fulfilling the inclusion criteria, developers are contacted to investigate possible options to extract recommendations from the guidelines.
Depending on the level of agreement and on the degree of release of Intellectual Property Rights (IPR) obtained from the guidelines developer, the displaying of guidelines included in the platform can vary.
4. Updating process for the Guidelines Platform
Updates of guidelines included in the platform have to undergo the same evaluation process applied for their inclusion in the platform (scoring against AGREEII domains and inclusion in the platform if fulfilling the scoring requirements).
The guidelines and related updates are discarded from the platform after 10 years from their publication.