How can you assess the strength and validity of a clinical guideline?

We will be discussing Diagnosis and management of endometriosis: a systematic review of international and national guidelines. Hirsch et al. BJOG 10.1111/1471-0528.14838 on Wednesday 29 November, 8pm BST.

A new guideline on the diagnosis and management of endometriosis is released by a prestigious medical society or association. You typically agree with the recommendations and adhere to the guidelines set forth by this group, but tend to be frustrated by recommendations that are based on expert opinion alone.

How can an informed reader of the obstetrics & gynecology literature assess the strength and validity of a clinical guideline and its recommendations?

Description of Research:
Study Design: Systematic review of clinical guidelines for endometriosis
Methods: Four authors assess quality using the Appraisal of Guidelines for Research & Evaluation (AGREE-II) tool.
Comparison: Total guideline score: low quality (0-33%), moderate quality (34-66%), and high quality (67%-100%).
Outcomes: Two guidelines were high quality, four were moderate quality, and one was low quality. No guidelines followed the standardized AGREE-II approach.
Authors’ Conclusions: There is substantial variation in recommendations and methodological quality of endometriosis guidelines. Future guidelines should be developed using high quality methodology.

Discussion Points:
• How are systematic reviews and guidelines similar? How do they differ?
• For endometriosis, what kind of stakeholder groups should be included in the making of guidelines, in your opinion?
• How can writers of guidelines for endometriosis or other topics improve the methods and reporting of recommendations based on expert opinion when data are lacking?
• What benefits may authors expect by including patients or patient advocates in the systematic review process?

1. AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Safe Health Care. 2003;12:18-23.
2. Khan K. The CROWN initiative: journal editors invite research to develop core outcomes in women’s health. BJOG 2014;121:1181-2.
3. Duffy JMN et al. Core outcome sets in women’s and newborn health: a systematic review. BJOG 2017;124:1481-1489.