我国肿瘤临床治疗现行指南制定的现状分析及循证指南评价
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篇名: 我国肿瘤临床治疗现行指南制定的现状分析及循证指南评价
TITLE:
摘要: 目的:调查分析我国肿瘤临床治疗现行指南制定的现状。方法:系统检索中国生物医学文献数据库、中国知网、万方数据库中关于我国肿瘤临床治疗指南的文献,检索时限均为建库起至2017年9月。描述性分析指南的基本特征(如基本信息、制定组织、肿瘤类型、制定方法等),并使用AGREEⅡ工具评价其中循证指南的质量。结果与结论:共纳入指南61部,包括西医指南55部、中医指南6部,42部指南为相关行业学会制定、9部指南为国家卫生和计划生育委员会制定(包括3部规范)、6部指南为相关医院制定、4部指南为其他组织制定,发表时间为2002-2017年;指南发表机构主要为中华医学会系列杂志与相关学术会议;指南涉及的肿瘤类型基本覆盖我国死亡率排名靠前的恶性肿瘤(如肝癌9部,妇科肿瘤、肠癌各7部,淋巴瘤/白血病6部,肺癌5部,乳腺癌、胰腺癌、口腔癌各4部);制定方法包括研讨会和共识、循证制定、文献综述、德尔菲法和研讨会、参考国外文献等。61部指南中14部为循证指南,这14部循证指南的6个评价领域(范围和目的、参与人员、制定严谨性、表达明晰性、应用性、编辑独立性)的平均得分分别为89%、33%、38%、77%、49%、2%,总体质量不高。我国肿瘤临床治疗指南制定工作起步晚、数量少、指南类型分布差异大、发展速度慢、多未更新(仅9部为更新后的版本)、质量有待提升。现有指南与我国肿瘤疾病负担的巨大需求和高风险不相适应,亟需高质量的肿瘤临床治疗循证指南、抗肿瘤药物临床用药循证指南的完善。
ABSTRACT: OBJECTIVE: To investigate and analyze the status quo of formulation of clinical guidelines in force for cancer treatment in China. METHODS: Retrieved from CBM, CNKI and Wanfang database, the literatures about clinical guidelines for cancer treatment were collected during database establishment and Sept. 2017. General characteristics of guideline were analyzed descriptively (general information, formulation institution, cancer type, formulation method, etc.), and AGREEⅡ tool was used to evaluate the quality of evidence-based guideline. RESULTS & CONCLUSIONS: A total of 61 guidelines were included, involving 55 western medicine guidelines, 6 Chinese medicine guidelines; 42 guidelines were formulated by related industrial associations, 9 by National Health and Family Planning Committee (including 3 specifications), 6 by related hospitals, 4 by other institutions. The publication time ranged 2002-2017. Guideline publication institutions included journals of Chinese Medical Association and related academic conferences. Top malignant cancer in the list of mortality were involved in China (such as liver cancer in 9 guidelines, gynecologic cancer and colon cancer in 7 guidelines, lymphoma/leukemia in 6 guidelines, lung cancer in 5 guidelines, breast cancer, pancreatic cancer and oral cancer in 4 guidelines). The formulation methods included seminar and consensus, evidence-based formulation, literature review, Delphi and seminars, and reference to foreign literature. Among 61 guidelines, 14 guidelines were evidence-based guideline. Average scores of 6 evaluation items (scope and object, participants, rigorous formulation, clear expression, applicability, editorial independence) in 14 guidelines were 89%, 33%, 38%, 77%, 49%, 2%, the quality of which were not high. Formulation of clinical guideline of cancer treatment in China starts late and has a small number; there are large differences in the distribution of guidance types, slow development (only 9 guidelines were update edition); most of the guidelines have not been updated; their qualities need to be improved. The current guidelines are not compatible with the huge demand and high risk of cancer burden in China. Therefore, it is urgent to develop high quality evidence-based clinical treatment guidelines for cancer and perfect evidence-based guidelines for clinical use of antitumor drugs.
期刊: 2018年第29卷第13期
作者: 宋再伟,谈志远,赵荣生
AUTHORS: SONG Zaiwei,TAN Zhiyuan,ZHAO Rongsheng
关键字: 肿瘤;临床治疗;指南;循证;评价
KEYWORDS: Cancer; Clinical treatment; Guideline; Evidence-based; Evaluation
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