Abstract
The expansion in the variety of clinical guidelines in oncology is perceptible worldwide, highlighting the need to guarantee the quality of these documents. The study thus aimed to assess the quality of Brazilian national guidelines for treatments of breast, prostate, and colon and rectal cancers. We selected 12 Brazilian guidelines published by four different drafting groups (Ministry of Health, Supplementary Health System, and medical societies and associations), and the AGREE II instrument was applied. In all these guidelines, we identified important weaknesses in more than one Domain, especially low values for "applicability" and "editorial independence". The patterns observed per Domains are more related to the drafting group than the respective clinical conditions. Lower scores in "drafting rigor" and "editorial independence" were obtained by nongovernmental drafting groups, including absence of information or lack of its transparency. Although the "clarity of presentation" in the Ministry of Health guidelines was relatively lower, all the guidelines presented major limitations in "applicability". Consequently, in the overall assessment, none of the guidelines was recommended without modifications, and four were not recommended at all. Finally, it is necessary to upgrade the guidelines according to the underlying evidence ("methodological rigor") and to present the recommended practices in a comprehensible and applicable way ("applicability"), and to mitigate conflicting interests in order to offer cancer patients the best available care in Brazil.
Highlights
Isso pode estar relacionado justamente com a dificuldade de atingir a amplitude do propósito a ser contemplado 37, embora já tenha sido verificado que diretrizes elaboradas por sistemas de saúde sem fins lucrativos estejam mais associadas ao melhor desempenho na “aplicabilidade”, quando comparadas a diretrizes de outras origens 49
Torna pública a decisão de incorporar a abiraterona para o câncer de próstata metastático resistente à castração de pacientes com uso prévio de quimioterapia, conforme a Assistência Oncológica no SUS, no âmbito do Sistema Único de Saúde – SUS
Summary
Foram avaliadas 12 diretrizes, quatro por tipo de câncer, cujos grupos elaboradores contemplaram instituições de saúde pública [21,22,23], Associação Médica Brasileira (AMB) em colaboração com a Agência Nacional de Saúde Suplementar (ANS) 24,25,26, instituição privada de saúde 27, assim como de sociedade médica (Sociedade Brasileira de Oncologia Clínica – SBOC) 28,29,30 (Quadro 1). O primeiro caso esteve relacionado ao fato de o objetivo maior estar disposto de formas distintas nas diretrizes da operadora privada de plano de saúde (gestão dos procedimentos prestados vs tomada de decisão clínica pelos médicos), e o segundo por não dispor o escopo em local de fácil identificação, sendo o mesmo interpretado por Quadro 1 Características das diretrizes clínicas nacionais na área de oncologia, selecionadas por tipo de câncer
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