Analytical frameworks in colorectal cancer guidelines: development of methods for systematic reviews, their application and practical guidance for their use

Samer G Karam; Andrea J Darzi; Antonio Bognanni; Rami Z Morsi; Elie E Tannous; Rana Charide; Se-In Choe; Rosa Stalteri; Yung Lee; Thomas Piggott; Laura Jewell; Finn Schünemann; Miranda Langendam; Elena Parmelli; Zuleika Saz-Parkinson; Annett Roi; Nadia Vilahur; Yasaman Vali; Siw Waffenschmidt; Douglas K Owens; Grigorios I Leontiadis; Paul Moayyedi; Jan L Brozek; Holger J Schünemann

doi:10.1016/j.jclinepi.2022.06.005

Analytical frameworks in colorectal cancer guidelines: development of methods for systematic reviews, their application and practical guidance for their use

J Clin Epidemiol. 2022 Sep:149:206-216. doi: 10.1016/j.jclinepi.2022.06.005. Epub 2022 Jun 17.

Authors

Samer G Karam¹, Andrea J Darzi¹, Antonio Bognanni¹, Rami Z Morsi², Elie E Tannous³, Rana Charide⁴, Se-In Choe⁵, Rosa Stalteri¹, Yung Lee⁵, Thomas Piggott¹, Laura Jewell⁶, Finn Schünemann⁷, Miranda Langendam⁸, Elena Parmelli⁹, Zuleika Saz-Parkinson⁹, Annett Roi⁹, Nadia Vilahur⁹, Yasaman Vali⁸, Siw Waffenschmidt¹⁰, Douglas K Owens¹¹, Grigorios I Leontiadis¹², Paul Moayyedi¹², Jan L Brozek¹³, Holger J Schünemann¹⁴

Affiliations

¹ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada; Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada.
² Department of Neurology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA.
³ Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
⁴ AUB GRADE Center, Clinical Research Institute, American University of Beirut, Riad El Solh, Beirut 1107-2020, Lebanon.
⁵ Department of Surgery, McMaster University, Hamilton, Canada.
⁶ Memorial University of Newfoundland, Discipline of Family Medicine, Happy Valley-Goose Bay, Canada.
⁷ Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Breisacher Str. 86, Freiburg 79110, Germany.
⁸ Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health institute, University of Amsterdam, Amsterdam, the Netherlands.
⁹ European Commission, Joint Research Centre (JRC), Ispra, Italy.
¹⁰ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada; Institute for Quality and Efficiency in Health Care, Cologne, Germany.
¹¹ Stanford Health Policy, Department of Medicine and Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA.
¹² Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
¹³ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁴ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St West; Hamilton, Ontario L8N 3Z5, Canada; Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milano, Italy. Electronic address: schuneh@mcmaster.ca.

PMID: 35724863
DOI: 10.1016/j.jclinepi.2022.06.005

Abstract

Objectives: Analytical frameworks are graphical representation of the key questions answered by a systematic review and can support the development of guideline recommendations. Our objectives were to a) conduct a systematic review to identify, describe and compare all analytical frameworks published as part of a systematic and guideline development process related to colorectal cancer (CRC), and b) to use this case study to develop guidance on how to conduct systematic reviews of analytical frameworks.

Methods: We developed a search strategy to identify eligible studies in Medline and Embase from 1996 until December 2020. We also manually searched guideline databases and websites to identify all guidelines and systematic reviews in CRC that used an analytical framework. We assessed the quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool. The systematic review was registered in International Prospective Register of Systematic Reviews, registration CRD42020172117.

Results: We screened 34,505 records and identified 1,166 guidelines and 3,127 systematic reviews on CRC of which five met our inclusion criteria. These five publications included four analytical frameworks in colorectal cancer (one update). We also describe our methodological approach to systematic reviews for analytical frameworks and underlying concepts for developing analytical framework using a bottom-up or top-down approach.

Conclusion: Few guidelines and systematic reviews are utilizing analytical frameworks in the development of recommendations. Development of analytical frameworks should begin with a systematic search for existing analytical frameworks and follow a structured conceptual approach for their development to support guideline recommendations. Our methods may be helpful in achieving these objectives.

Keywords: Analytical framework; Graphical diagram; Guidelines; Key questions; Recommendations; Systematic review.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Colorectal Neoplasms* / therapy
Databases, Factual
Humans
MEDLINE
Systematic Reviews as Topic