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Maes-Carballo M. Shared decision making in surgery, why is it important? J Healthc Qual Res 2024:S2603-6479(24)00003-4. [PMID: 38267360 DOI: 10.1016/j.jhqr.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Affiliation(s)
- M Maes-Carballo
- Servicio de Cirugía General y Aparato Digestivo del Hospital Público de Verín, Ourense, Spain; Vocal del Comité de Ética Asistencial del Área Sanitaria de Ourense, Spain; Vocal del Comité Deontológico del Colegio de Médicos de Ourense, Spain.
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Maes-Carballo M, Martín-Díaz M, Mignini L, Khan KS, Trigueros R, Bueno-Cavanillas A. Quality indicators for the diagnosis and treatment of breast cancer integrated assistance: A critical appraisal. Semergen 2024; 50:102067. [PMID: 37827047 DOI: 10.1016/j.semerg.2023.102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/11/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Quality indicators (QIs) are essential for adequate control of the health care management process, recognizing areas of improvement and providing solutions. We aimed to evaluate the Integrated Breast Cancer (BC) Care Process QIs. METHODS We studied 487 consecutive BC cases diagnosed from November 1st, 2013, to November 30th, 2019, in a Spanish healthcare area, and we estimated the associated QIs. RESULTS Four indicators did not meet the standards and were analysed based on related sociodemographic and clinical variables. The surgical delay after a multidisciplinary team discussion (mean 64%, IQR 59.6-68.5) was lower in elder people (p=0.027), and early histological grades (p=0.019) and stages (p=0.008). The adjuvant treatment delay (mean 55.7%, IQR 51.1-60.3) was lower in advance stages (p=0.002) and when there was no reoperation (p=0.001). The surgical delay after inclusion (mean 83.2%, IQR 79.3-87.2) was lower in early histological grades (p=0.048). The immediate reconstruction (mean 42.3%, IQR 34.0-50.5) reached 72.3% in young women compared to 11.8% in older than 70 years (p=0.001) and it was higher in early stages (45.3% vs 36.2%; p=0.049). CONCLUSION The study of QIs evaluated their compliance and analysed the variables influencing them to propose improvement measures. Not all the indicators were equally valuable. Some depended on the available resources, and others on the mix of patients or complementary treatments. It would be essential to identify the specific target populations to estimate the indicators or provide standards stratified by the related variables.
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Affiliation(s)
- M Maes-Carballo
- Academic Department of General Surgery, Complexo Universitario Hospitalario de Ourense, Spain; Academic Department of General Surgery, Hospital Público de Verín, Spain; Department of Preventive Medicine and Public Health, University of Granada, Spain.
| | - M Martín-Díaz
- Academic Department of General Surgery, Hospital Santa Ana de Motril, Spain
| | - L Mignini
- Unidad de Mastología de Grupo Oroño, Rosario, Argentina
| | - K S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - R Trigueros
- Department of Psychology, University of Almeria, Spain
| | - A Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
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Maes-Carballo M, García-García M, Rodríguez-Janeiro I, Cámara-Martínez C, Alberca-Remigio C, Khan KS. A systematic review of robotic breast surgery versus open surgery. J Robot Surg 2023; 17:2583-2596. [PMID: 37624486 DOI: 10.1007/s11701-023-01698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Robotic-assisted breast surgery (RABS) is controversial. We systematically reviewed the evidence about RABS, comparing it to open conventional breast surgery (CBS). Following prospective registration (osf.io/97ewt), a search was performed in January 2023, without time or language restrictions, through bibliographic databases (PubMed, Web of Science, EMBASE, Scopus, Trip database and CDSR) and grey literature. Quality was assessed in duplicate using Qualsyst criteria (score range 0.0-1.0); reviewer agreement was 98%. The 16 selected studies (total patients: 334,804) had overall high quality (mean score 0.82; range 0.68-0.91). Nine of 16 (56.3%) were cohort studies, 2/16 (12.5%) RCTs, and 5/16 (31.3%) case-control studies. Taking p < 0.05 as the significance threshold, RABS versus CBS was better in aesthetic results and patient satisfaction (10/11 studies; 90%), was surgically costly (4/4 studies; 100%), time-consuming (9/13 studies; 69%), and less painful in the first 6-24 h (2/2 studies; 100%) and without statistically significant differences in complication rates (10/12 studies; 83%) or short-term oncological outcomes (10/10 studies; 100%). Surgical time could be dramatically reduced by training surgical teams, reaching no significant differences between approaches (p = 0.120). RABS was shown to be feasible and safe. The advantages of RABS and long-term outcomes need further research.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain.
- Hospital Público de Verín, Ourense, Spain.
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
- Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain
- Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iago Rodríguez-Janeiro
- Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Claudia Alberca-Remigio
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Maes-Carballo M, Gómez-Fandiño Y, García-García M, Martín-Díaz M, De-Dios-de-Santiago D, Khan KS, Bueno-Cavanillas A. Colorectal cancer treatment guidelines and shared decision making quality and reporting assessment: Systematic review. Patient Educ Couns 2023; 115:107856. [PMID: 37451055 DOI: 10.1016/j.pec.2023.107856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Physicians must share decisions and choose personalised treatments regarding patients´ beliefs and values. OBJECTIVE To analyse the quality of the recommendations about shared decision making (SDM) in colorectal (CRC) and anal cancer treatment clinical practice guidelines (CPGs) and consensus statements (CSs). METHODS Guidelines were systematically reviewed following prospective registration (Prospero: CRD42021286146) without language restrictions searching 15 databases and 59 professional society websites from January 2010 to November 2021. A validated 31-item SDM quality assessment tool was employed to extract data in duplicate. RESULTS We identified 134 guidelines. Only 46/134 (34.3 %) mentioned SDM. Fifteen (11.1 %) made clear, precise and actionable recommendations, while 9/134 (6.7 %) indicated the strength of the SDM-related recommendations. CPGs underpinned by systematic reviews reported SDM more often than those based on consensus or reviews (35.9 % vs 32.0 %; p = 0.031). Guidelines that reported following quality tools (i.e., AGREE II) more commonly commented about SDM than when it was not reported (75.0 % vs 32.0 %; p = 0.003). CONCLUSION AND PRACTICE IMPLICATIONS Most of the CRC and anal treatment guidelines did not mention SDM and it was superficial. Guidelines based on systematic reviews and those using quality tools demonstrated better reporting of SDM. Recommendations about SDM in these guidelines merit urgent improvement.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; Hospital Público de Verín, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Núñez-Núñez M, Maes-Carballo M, Mignini LE, Chien PFW, Khalaf Y, Fawzy M, Zamora J, Khan KS, Bueno-Cavanillas A. Research integrity in randomized clinical trials: A scoping umbrella review. Int J Gynaecol Obstet 2023; 162:860-876. [PMID: 37062861 DOI: 10.1002/ijgo.14762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Randomized clinical trials (RCTs) are experiencing a crisis of confidence in their trustworthiness. Although a comprehensive literature search yielded several reviews on RCT integrity, an overarching overview is lacking. OBJECTIVES The authors undertook a scoping umbrella review of the research integrity literature concerning RCTs. SEARCH STRATEGY AND SELECTION CRITERIA Following prospective registration (https://osf.io/3ursn), two reviewers independently searched PubMed, Scopus, The Cochrane Library, and Google Scholar, without language or time restrictions, until November 2021. The authors included systematic reviews covering any aspect of research integrity throughout the RCT lifecycle. DATA COLLECTION AND ANALYSIS The authors assessed methodological quality using a modified AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool and collated the main findings. MAIN RESULTS A total of 55 relevant reviews, summarizing 6001 studies (median per review, 63; range, 8-1106) from 1964 to 2021, had an overall critically low quality of 96% (53 reviews). Topics covered included general aspects (15%), design and approval (22%), conduct and monitoring (11%), reporting (38%), postpublication concerns (2%), and future research (13%). The most common integrity issues covered were ethics (18%) and transparency (18%). CONCLUSIONS Low-quality reviews identified various integrity issues across the RCT lifecycle, emphasizing the importance of high ethical standards and professionalism while highlighting gaps in the integrity landscape. Multistakeholder consensus is needed to develop specific RCT integrity standards.
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Affiliation(s)
- María Núñez-Núñez
- Pharmacy Department, University Hospital Clínico San Cecilio, Granada, Spain
- Biomedical research institute of Granada (IBS-Granada), Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
| | - Marta Maes-Carballo
- General Surgery Department. Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
- General Surgery Department, Hospital Público Verín, Ourense, Spain
| | | | | | - Yacoub Khalaf
- Guy's & St Thomas' Hospital Foundation Trust, London, UK
| | - Mohamed Fawzy
- IbnSina (Sohag), Banon (Assiut), Qena (Qena), Amshag (Sohag) IVF Facilities, Cairo, Egypt
| | - Javier Zamora
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Khalid S Khan
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP-Spain), Madrid, Spain
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Spain
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Rivera-Izquierdo M, Maes-Carballo M, Jiménez-Moleón JJ, Martínez-Ruiz V, Blaakaer J, Olmedo-Requena R, Khan KS, Jørgensen JS. Gender bias in shared decision-making among cancer care guidelines: A systematic review. Health Expect 2023; 26:1019-1038. [PMID: 37016907 PMCID: PMC10154819 DOI: 10.1111/hex.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/09/2023] [Accepted: 03/03/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and consensus statements may have potential differences by gender. OBJECTIVE To systematically analyse recommendations concerning shared decision-making in CPGs and consensus statements for the most frequent cancers exclusively among males (prostate) and females (endometrial). SEARCH STRATEGY We prospectively registered the protocol at PROSPERO (ID: RD42021241127). MEDLINE, EMBASE, Web of Science, Scopus and online sources (8 guideline databases and 65 professional society websites) were searched independently by two reviewers, without language restrictions. INCLUSION CRITERIA CPGs and consensus statements about the diagnosis or treatment of prostate and endometrial cancers were included from January 2015 to August 2021. DATA EXTRACTION AND SYNTHESIS Quality assessment deployed a previously developed 31-item tool and differences between the two cancers analysed. MAIN RESULTS A total of 176 documents met inclusion criteria, 97 for prostate cancer (84 CPGs and 13 consensus statements) and 79 for endometrial cancer (67 CPGs and 12 consensus statements). Shared decision-making was recommended more often in prostate cancer guidelines compared to endometrial cancer (46/97 vs. 13/79, 47.4% vs. 16.5%; p < .001). Compared to prostate cancer guidelines (mean 2.14 items, standard deviation 3.45), compliance with the shared-decision-making 31-item tool was lower for endometrial cancer guidelines (mean 0.48 items, standard deviation 1.29) (p < .001). Regarding advice on the implementation of shared decision-making, it was only reported in 3 (3.8%) endometrial cancer guidelines and in 16 (16.5%) prostate cancer guidelines (p < .001). DISCUSSION AND CONCLUSIONS We observed a significant gender bias as shared decision-making was systematically more often recommended in the prostate compared to endometrial cancer guidelines. These findings should encourage new CPGs and consensus statements to consider shared decision-making for improving cancer care regardless of the gender affected. PATIENT OR PUBLIC CONTRIBUTION The findings may inform future recommendations for professional associations and governments to update and develop high-quality clinical guidelines to consider patients' preferences and shared decision-making in cancer care.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Service of Preventive Medicine, Hospital Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
| | - Marta Maes-Carballo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Academic Department of General Surgery, Complexo Hospitalario de Ourense, Ourense, Spain
- Academic Department of General Surgery, Hospital Público de Verín, Verín, Spain
| | - José J Jiménez-Moleón
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Virginia Martínez-Ruiz
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Jan Blaakaer
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Rocío Olmedo-Requena
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Khalid S Khan
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Jan S Jørgensen
- Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Maes-Carballo M, García-García M, Martín-Díaz M, Estrada-López CR, Iglesias-Álvarez A, Filigrana-Valle CM, Khan KS, Bueno-Cavanillas A. A comprehensive systematic review of colorectal cancer screening clinical practices guidelines and consensus statements. Br J Cancer 2023; 128:946-957. [PMID: 36476659 PMCID: PMC9734419 DOI: 10.1038/s41416-022-02070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
High-quality clinical practice guidelines (CPGs) and consensus statements (CSs) are essential for evidence-based medicine. The purpose of this systematic review was to appraise the quality and reporting of colorectal cancer (CRC) screening CPGs and CSs. After prospective registration (Prospero no: CRD42021286156), a systematic review searched CRC guidances in duplicate without language restrictions in ten databases, 20 society websites, and grey literature from 2018 to 2021. We appraised quality with AGREE II (% of maximum score) and reporting with RIGHT (% of total 35 items) tools. Twenty-four CPGs and 5 CSs were analysed. The median overall quality and reporting were 54.0% (IQR 45.7-75.0) and 42.0% (IQR 31.4-68.6). The applicability had low quality (AGREE II score <50%) in 83% of guidances (24/29). Recommendations and conflict of interest were low-reported (RIGHT score <50%) in 62% guidances (18/29) and 69% (20/29). CPGs that deployed systematic reviews had better quality and reporting than CSs (AGREE: 68.5% vs. 35.5%; p = 0.001; RIGHT: 74.6% vs. 41.4%; p = 0.001). In summary, CRC screening CPGs and CSs achieved low quality and reporting. It is necessary a revision and an improvement of the current guidances. Their development should apply a robust methodology using proper guideline development tools to obtain high-quality evidence-based documents.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain. .,Hospital Público de Verín, Ourense, Spain. .,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
| | - Manuel García-García
- Department of General Surgery, Breast cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | | | | | | | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Maes-Carballo M, Martín-Díaz M, García-García M, Reinoso-Hermida A, Mignini L, Teixeira-Arcaya RP, Khan KS, Bueno-Cavanillas A. Decision Aids for Decision Making about Locally Advance Breast Cancer: A Systematic Review. Cancer Invest 2023; 41:1-13. [PMID: 36591950 DOI: 10.1080/07357907.2023.2164895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/03/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023]
Abstract
Locally advanced breast cancer (LABC) is a subset of breast cancer with locoregional progression without distant metastasis. The multimodality treatment (surgery, chemotherapy, radiotherapy, hormonal and targeted therapy if required) could significantly improve results in this specific group of patients. The complex and multiple options of treatment with similar mortality rates but different outcomes depending on the patient's desires, preferences and social environment require aid to facilitate the individual patient's decisions (e.g. Decision Aids (DAs) targeting patients considering primary or adjuvant treatment in LABC). In this context, DAs have been proven fundamental to help patients and clinicians share and agree on the best value option. The current systematic review aimed to evaluate the existing DAs related to these patients with LABC and identify current status and possible improvement areas (possible scarcity and heterogeneity of instruments, the status of their development, explanation of their purpose,…). No previous systematic reviews have been published on this topic. Following Prospero registration no: CRD42021286173, studies about LABC DAs were identified, without data or language restrictions, through a systematic search of bibliographic databases in December 2021. Quality was assessed using Qualsyst criteria (range 0.0-1.0). The quality of the 17 selected studies ranged from 0.46 to 0.95. Of them, 14/17 (82%) were DAs about treatment, only one (6%) about diagnosis, and 2/17 (12%) about the employment of DAs. No screening or follow-up DAs were retrieved. Twelve (70.6%) DAs were online tools. They varied broadly regarding their characteristics and purposes. Most of the studies focused on developing and testing different DAs (5/17; 29.4%) and their impact (7/17; 41.2%). Only 4/17 (23.5%) analysed their implementation and cost. These instruments have proven to improve patient's knowledge and decision-making, decrease patient anxiety, and patients tend to undergo treatment. However, nowadays, there is still a need for further research and consensus on methodology to develop practical DAs.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
- Department of General Surgery, Hospital Público de Verín, Ourense, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Manuel Martín-Díaz
- Department of General Surgery, Hospital Santa Ana de Motril, Granada, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
- Departmento de Cirugía General, Unidad de Mastología de Grupo Oroño, Rosario, Argentina
| | - Ayla Reinoso-Hermida
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Luciano Mignini
- Departmento de Cirugía General, Unidad de Mastología de Grupo Oroño, Rosario, Argentina
| | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
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Maes-Carballo M, García-García M, Gómez-Fandiño Y, De-Dios-de-Santiago D, Martínez-Martínez C, Bueno-Cavanillas A, Khan KS. Guidance documents for colorectal and anal cancer treatment: A systematic quality and reporting assessment. Colorectal Dis 2022; 24:1472-1490. [PMID: 35852231 DOI: 10.1111/codi.16270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
AIM Evidence-based medicine is essential for clinical practice. Clinical practice guidelines (CPGs) and consensus statements (CSs) ought to follow a consistent methodology to underpin high-quality healthcare. We systematically analysed the quality and reporting of colorectal (CRC) and anal cancer CPGs and CSs. METHODS Embase, MEDLINE, Scopus, Web of Science, the Cochrane Database of Systematic Reviews and online sources (59 professional society websites and eight guideline databases) were systematically searched following prospective registration (PROSPERO no. CRD42021286146) by two reviewers independently, without language restrictions. CPGs and CSs about CRC and anal cancer treatment were included from January 2018 to November 2021 and were assessed using the AGREE II tool (per cent of maximum score) and the RIGHT tool (per cent of total 35 items) for quality and reporting respectively. RESULTS The median overall quality and reporting of the 59 guidelines analysed were 55.0% (interquartile range 47.0-62.0) and 58% (interquartile range 50.0-67.9), respectively, with a proportion scoring less than half (<50%) for quality (20/59, 33.9%) and reporting (15/59, 25.4%). Guidance reported that following AGREE II methodology scored better on average than that without (AGREE II 77.7% vs. 47.6%, P = 0.001; RIGHT 50.0% vs. 33.9%, P = 0.001). Guidelines based on systematic reviews had better quality and reporting on average than those based on consensus (AGREE II 56.5% vs. 46.6%, P = 0.001; RIGHT 36.9% vs. 35.4%, P = 0.019). CONCLUSION The quality and reporting of colorectal and anal cancer treatment CPGs and CSs were poor. Despite AGREE II and RIGHT inherent methodological limitations, few high-quality guidelines were found. Despite wide variability in scoring different domains, they merit urgent improvement in all areas. It has also been demonstrated that CPGs and CSs should be underpinned by systematic reviews collecting the best available clinical research findings.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain.,Hospital Público de Verín, Ourense, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | | | - Carmen Martínez-Martínez
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Maes-Carballo M, Mignini L, Martín-Díaz M, Bueno-Cavanillas A, Khan KS. Clinical practice guidelines and consensus for the screening of breast cancer: A systematic appraisal of their quality and reporting. Eur J Cancer Care (Engl) 2021; 31:e13540. [PMID: 34951075 DOI: 10.1111/ecc.13540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Clinical practice guidelines (CPGs) and consensus statements (CSs) are being promoted to provide high-quality healthcare guidance. This systematic review has assessed the breast cancer (BC) screening CPGs and CSs quality and reporting. METHODS A search of bibliographic databases (MEDLINE, Embase, Web of Science, Scopus and CDSR), 12 guideline databases and 51 professional society websites was performed without language restrictions from January 2017 to June 2020, following prospective registration (Prospero no.: CRD42020203807). AGREE II (% of maximum score) and RIGHT (% of total 35 items) appraised quality and reporting individually, extracting data in duplicate; reviewer agreement was 98% and 93%, respectively. RESULTS Forty guidances with median overall quality and reporting 51% (interquartile range [IQR] 39-63) and 48% (IQR 35-65), respectively. Twenty-two (55%) and 20 (50%) did not reach the minimum standards (scores <50%). The guidances that deployed systematic reviews had better quality (74.2% vs. 46.9%; p = 0.001) and reporting (80.5% vs. 42.6%; p = 0.001). Guidances reporting a tool referral scored better (AGREE II: 72.8% vs. 43.1%, p = 0.002; RIGHT: 75.0% vs. 46.9%, p = 0.004). CONCLUSION BC screening CPGs and CSs suffered poor quality and reporting. More than half did not reach the minimum standards. They would improve if systematic reviews were used to underpin the recommendations made.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.,Department of General Surgery, Hospital Público de Verín, Ourense, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | | | | | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.,Instituto de Investigación Biosanitaria, IBS, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
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Maes-Carballo M, Gómez-Fandiño Y, Reinoso-Hermida A, Estrada-López CR, Martín-Díaz M, Khan KS, Bueno-Cavanillas A. Quality indicators for breast cancer care: A systematic review. Breast 2021; 59:221-231. [PMID: 34298301 PMCID: PMC8322135 DOI: 10.1016/j.breast.2021.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/18/2021] [Accepted: 06/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives We evaluated breast cancer (BC) care quality indicators (QIs) in clinical pathways and integrated health care processes. Methods Following protocol registration (Prospero no: CRD42021228867), relevant documents were identified, without language restrictions, through a systematic search of bibliographic databases (EMBASE, Scopus, Web of Science, MEDLINE), health care valuable representatives and the World Wide Web in April 2021. Data concerning QIs, measurement tools and compliance standards were extracted from European and North American sources in duplicate with 98% reviewer agreement. Results There were 89 QIs found from 22 selected documents (QI per document mean 13.5 with standard deviation 11.9). The Belgian (38 QIs) and the EUSOMA (European Society of Breast Cancer Specialists) (34 QIs) documents were the ones that best reported the QIs. No identical QI was identified in all the documents analysed. There were 67/89 QIs covering processes (75.3%) and 11/89 (12.4%) for each structure and outcomes QIs. There were 21/89 QIs for diagnosis (30.3%), 43/89 for treatment (48.3%), and 19/89 for staging, counselling, follow-up and rehabilitation (21.4%). Of 67 process QIs and 11 outcome QIs, 20/78 (26%) did not report a minimum standard of care. Shared decision making was only included as a QI in the Italian document. Conclusion More than half of countries have not established a national clinical pathway or integrated breast cancer care process to achieve the excellence of BC care. There was heterogeneity in QIs for the evaluation of BC care quality. Over two-thirds of the clinical pathways and integrated health care processes did not provide a minimum auditable standard of care for compliance, leaving open the definition of best practice. There is a need for harmonisation of BC care QIs. The quality of breast cancer care has become a preference for health systems. There was no established set of quality indicators to harmonise BC quality management’s evaluation. A consensus is needed. Most of the integrated breast cancer care processes or clinical pathways did not indicate any standard for care compliance. No quality indicators specifically related to patient satisfaction or Primary care were found in our study. Shared decision making was only included as a QI in the Italian document. There is a vast space for improvement, and future studies should pay attention to this issue.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Complexo Hospitalario de Ourense, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Department of General Surgery, Hospital de Verín, Ourense, Spain.
| | | | | | | | - Manuel Martín-Díaz
- Department of General Surgery, Hospital Santa Ana de Motril, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
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12
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Maes-Carballo M, Moreno-Asencio T, Martín-Díaz M, Mignini L, Bueno-Cavanillas A, Khan KS. Shared decision making in breast cancer screening guidelines: a systematic review of their quality and reporting. Eur J Public Health 2021; 31:873-883. [PMID: 34148093 DOI: 10.1093/eurpub/ckab084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) is a key component of evidence-based and patient-centred care. The aim of this study is to systematically review the quality of SDM proposals in clinical practice guidelines (CPGs) and consensus statements (CSs) concerning breast cancer (BC) screening. METHODS Guidances were identified, without language restrictions, using a prospectively planned systematic search (MEDLINE, EMBASE, Web of Science, Scopus and guideline websites) from January 2010 to August 2020. Duplicate data extraction used a 31-item SDM quality assessment tool; reviewer agreement was 98%. RESULTS SDM appeared only in 38 (49.4%) (33/68 CPGs, 4/9 CSs) documents (overall compliance with the quality tool: mean 5.74, IQR 3-8). CPGs and CSs specifically mentioning the term SDM (n = 12) had higher quality (mean 6.8, IQR 4-9 vs. mean 2.1, IQR 0-3; P = 0.001). No differences were found in mean quality comparing CPGs with CSs (3 vs. 1.6; P = 0.634), use of systematic review (4.2 vs. 2.9; P = 0.929) and publication in a journal (4 vs. 1.9; P = 0.094). Guidances with SDM were more recently reported than those without it (mean 41 vs. 57 months; P = 0.042). CONCLUSION More than half of all the guidelines did not meet SDM quality criteria. Those that explored it were more recently reported. There is an urgent need for promoting SDM in guidances concerning BC screening issued by institutions, professional associations and medical journals.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Complexo Hospitalario de Ourense, Ourense, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Department of General Surgery, Hospital Público de Verín, Ourense, Spain
| | | | | | | | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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13
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Maes-Carballo M, Gómez-Fandiño Y, Estrada-López CR, Reinoso-Hermida A, Khan KS, Martín-Díaz M, Bueno-Cavanillas A. Breast Cancer Care Quality Indicators in Spain: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph18126411. [PMID: 34199302 PMCID: PMC8296231 DOI: 10.3390/ijerph18126411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 01/17/2023]
Abstract
Breast cancer (BC) management care requires an increment in quality. An initiative to improve the BC quality care is registered, and quality indicators (QIs) are studied. We appraised the appearance of QIs and their standards systematically in Spain. A prospective systematic search (Prospero no: CRD42021228867) for clinical pathways and integrated breast cancer care processes was conducted through databases and the World Wide Web in February 2021. Duplicate data extraction was performed with 98% reviewer agreement. Seventy-four QIs (QI per document mean: 11; standard deviation: 10.59) were found in 15 documents. The Catalonian document had the highest number of QIs (n = 30). No QI appeared in all the documents. There were 9/74 QIs covering structure (12.16%), 53/74 covering process (71.62%), and 12/74 covering outcome (16.22%). A total of 22/66 (33.33%) process and outcome QIs did not set a minimum standard of care. QIs related to primary care, patient satisfaction, and shared decision making were deficient. Most of the documents established a BC QI standard for compliance, but the high variability hinders the comparison of outcomes. Establishing a consensus-based set of QIs needs urgent attention.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (K.S.K.); (A.B.-C.)
- Department of General Surgery, Hospital Público de Verín, 32600 Ourense, Spain
- Correspondence:
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
| | - Carlos Roberto Estrada-López
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
| | - Ayla Reinoso-Hermida
- Department of General Surgery, Complexo Hospitalario de Ourense, 32005 Ourense, Spain; (Y.G.-F.); (C.R.E.-L.); (A.R.-H.)
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Manuel Martín-Díaz
- Department of General Surgery, Hospital de Motril, 18600 Granada, Spain;
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria IBS, 18012 Granada, Spain
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Maes-Carballo M, Martín-Díaz M, Mignini L, Khan KS, Trigueros R, Bueno-Cavanillas A. Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey. Int J Environ Res Public Health 2021; 18:2128. [PMID: 33671649 PMCID: PMC7926688 DOI: 10.3390/ijerph18042128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. MATERIALS AND METHODS A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. RESULTS The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36-4.55)) and were in favour of its implementation (mean 4.58 (4.51-4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37-3.55)) and agreed on policies that improved its implementation (3.96 (3.88-4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients' paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). CONCLUSIONS New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.
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Affiliation(s)
- Marta Maes-Carballo
- Unidad de Patología Mamaria del Servicio de Cirugía General, Complexo Universitario Hospitalario de Ourense, 32005 Ourense, Spain;
- Department of Preventive Medicine and Public Health, University of Granada, 18014 Granada, Spain; (K.S.K.); (A.B.-C.)
| | | | - Luciano Mignini
- Unidad de Mastología del Grupo Oroño, 2000 Rosario, Argentina;
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18014 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidimiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Rubén Trigueros
- Department of Language and Education, University of Antonio de Nebrija, 28015 Madrid, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, 18014 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidimiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain
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15
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Maes-Carballo M, Mignini L, Martín-Díaz M, Bueno-Cavanillas A, Khan KS. Quality and reporting of clinical guidelines for breast cancer treatment: A systematic review. Breast 2020; 53:201-211. [PMID: 32858405 PMCID: PMC7473996 DOI: 10.1016/j.breast.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High-quality, well-reported clinical practice guidelines (CPGs) and consensus statements (CSs) underpinned by systematic reviews are needed. We appraised the quality and reporting of CPGs and CSs for breast cancer (BC) treatment. METHODS Following protocol registration (Prospero no: CRD42020164801), CPGs and CSs on BC treatment were identified, without language restrictions, through a systematic search of bibliographic databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR) and online sources (12 guideline databases and 51 professional society websites) from January 2017 to June 2020. Data were extracted in duplicate assessing overall quality using AGREE II (% of maximum score) and reporting compliance using RIGHT (% of total 35 items); reviewer agreement was 98% and 96% respectively. RESULTS There were 59 relevant guidance documents (43 CPGs, 16 CSs), of which 20 used systematic reviews for evidence synthesis. The median overall quality was 54.0% (IQR 35.9-74.3) and the median overall reporting compliance was 60.9% (IQR 44.5-84.4). The correlation between quality and reporting was 0.9. Compared to CSs, CPGs had better quality (55.4% vs 44.2%; p = 0.032) and reporting (67.18% vs 44.5%; p = 0.005). Compared to subjective methods of evidence analysis, guidance documents that used systematic reviews had better quality (76.3% vs 51.4%; p = 0.001) and reporting (87.1% vs 59.4%; p = 0.001). CONCLUSION The quality and reporting of CPGs and CSs in BC treatment were moderately strong. Systematic reviews should be used to improve the quality and reporting of CPGs and CSs.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Complexo Hospitalario de Ourense, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
| | | | | | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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