Article type
Abstract
Background:
The evidence base for screening interventions is international, and a number of influential national guideline institutions synthesize evidence based on similar principles for evidence-based practice, yet recommendations sometimes differ. These differences can have a substantial impact on the lives of citizens.
Objective
To systematically collect and compare screening recommendations from the UK National Screening Committee (UKNSC), the Canadian Task Force on Preventive Health Care (CTFPHC), and the US Preventive Services Task Force (USPSTF). We also systematically collected and compared the stated reasons for each recommendation to explore differences.
Methods
Two observers (FGR and KJJ) systematically assessed the direction and stated rationale for all current (December 2023) screening recommendations from the UKNSC, CTFPHC, and the USPSTF. Data was extracted into an Excel template and compared through a consensus process.
Results
We divided screening recommendations from the 3 institutions into 3 categories: agreement between institutions either for or against screening, disagreement in terms of whether screening was either not recommended or no recommendation could be made, and disagreement where screening was either recommended or not. We focused on conditions with active guidelines. For 12 recommendations of 31 (39%) made by at least 2 institutions, recommendations agreed. For 10 recommendations of 31 (32%) made by at least 2 institutions, they differed regarding whether screening was not recommended or if no recommendation was made. In all these cases, the reason was that evidence was considered insufficient, which means the USPSTF made no recommendation and others recommended against. For 9 recommendations of 31 (29%) made by at least 2 institutions, recommendations pointed in opposite directions. In all such cases, the USPSTF recommended screening and another institution recommended against. The most common reason was difference in interpretation of evidence and/or requirements for the strength of the evidence
Conclusions
We found that, invariably, recommendations from the USPSTF were more favorable toward screening than those from the UKNSC or the CTFPHC. The USPSTF required weaker evidence to recommend screening, and their policy is that lack of evidence means a recommendation cannot be made, whereas this leads other institutions to recommend against screening.
The evidence base for screening interventions is international, and a number of influential national guideline institutions synthesize evidence based on similar principles for evidence-based practice, yet recommendations sometimes differ. These differences can have a substantial impact on the lives of citizens.
Objective
To systematically collect and compare screening recommendations from the UK National Screening Committee (UKNSC), the Canadian Task Force on Preventive Health Care (CTFPHC), and the US Preventive Services Task Force (USPSTF). We also systematically collected and compared the stated reasons for each recommendation to explore differences.
Methods
Two observers (FGR and KJJ) systematically assessed the direction and stated rationale for all current (December 2023) screening recommendations from the UKNSC, CTFPHC, and the USPSTF. Data was extracted into an Excel template and compared through a consensus process.
Results
We divided screening recommendations from the 3 institutions into 3 categories: agreement between institutions either for or against screening, disagreement in terms of whether screening was either not recommended or no recommendation could be made, and disagreement where screening was either recommended or not. We focused on conditions with active guidelines. For 12 recommendations of 31 (39%) made by at least 2 institutions, recommendations agreed. For 10 recommendations of 31 (32%) made by at least 2 institutions, they differed regarding whether screening was not recommended or if no recommendation was made. In all these cases, the reason was that evidence was considered insufficient, which means the USPSTF made no recommendation and others recommended against. For 9 recommendations of 31 (29%) made by at least 2 institutions, recommendations pointed in opposite directions. In all such cases, the USPSTF recommended screening and another institution recommended against. The most common reason was difference in interpretation of evidence and/or requirements for the strength of the evidence
Conclusions
We found that, invariably, recommendations from the USPSTF were more favorable toward screening than those from the UKNSC or the CTFPHC. The USPSTF required weaker evidence to recommend screening, and their policy is that lack of evidence means a recommendation cannot be made, whereas this leads other institutions to recommend against screening.