Critical Appraisal of Clinical Practice Guidelines for Adaptation in the Evidence-Based Guideline “Prevention of Skin Cancer”

Abstract

During guideline development, it is essential to systematically review existing guidelines that may be suitable for adaptation; however, such review is laborious and may not always uncover useful guidelines. To identify existing clinical practice guidelines and assess their methodologic quality and suitability for adaptation in the German evidence-based guideline "Prevention of Skin Cancer." A systematic literature search was performed across a range of databases and homepages of guideline development institutions. The AGREE Instrument (Appraisal of Guidelines Research and Evaluation) was used to assess the methodologic quality of selected guidelines. A total of 480 citations were identified and screened. Of these, 12 guidelines were deemed suitable for potential adaptation. After comprehensive quality assessment, only 2 melanoma guidelines, one from Australia/New Zealand and the other from Scotland, were identified as being of high methodologic quality according to predefined selection criteria. Subsequent synopsis, however, revealed that neither of these guidelines was sufficiently comprehensive for full adaptation. It is surprising that most existing skin cancer guidelines that contain aspects on prevention are not appropriate for adaptation, with most lacking methodologic quality, particularly rigor applied during the development process. Of the 2 guidelines that met the predefined quality criteria, only a few aspects--limited to malignant melanoma--were adaptable. We conclude that, despite the labor-intensive search for existing guidelines, a de novo development, including systematic literature review, is indispensible for the development of the German evidence-based guideline Prevention of Skin Cancer.