Abstract / Summary
Abstract Purpose: To identify an efficient approach for updating evidence in cancer symptom triage and management knowledge tools.
Methods: We analyzed evidence sources in four pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides. Two team members independently appraised quality of clinical practice guidelines (CPGs) using AGREE II rigour domain. We created a prioritization framework for selecting evidence sources and investigated changes that would have been missed if the update was limited to prioritized sources.
Results: The 56 new and 3 existing evidence sources (38 CPGs + 21 systematic reviews with meta-analysis) were for diarrhea (n = 8 + 1), constipation (7 + 0), fatigue (7 + 14), mouth sores (9 + 6) and immune checkpoint inhibitors (10 + 0). Systematic reviews were typically cited once and did not contribute novel evidence beyond what was reported in CPGs. Of 38 CPGs, 29 were identified by hand searching organizations with CPGs, 3 in database searches alone, and 6 in both. CPGs were cited 1 to 40 times (median 15) in a practice guide. The AGREE II rigour scores were 6% to 100% (median 77%). Applying the prioritization framework, all 21 systematic reviews and 7 CPGs could be removed with three missed items (acupuncture for constipation, assessing mouth sores if diarrhea, nystatin for oral candida).
Conclusion: The prioritization framework applied to four COSTaRS practice guides demonstrated it was possible to use a more efficient targeted process, without compromising the integrity of the evidence base. Future COSTaRS updates could be more efficient by limiting evidence sources to hand searching organizations that produce multiple, higher quality CPGs.