Identifying informal recommendations in Chinese clinical practice guidelines: A cross-sectional study

Poster
2024 Prague [Global Evidence Summit]
Jin Y1, Ren X1, Lotfi T2, Chen J3, Lei Y4, Zhou C3, Zhang W3, Huang Q1, Wang Y1, Yan S1, Yao X5, Schünemann H6
1Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
2Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada and GRADE Centre, McMaster University, Hamilton, Ontario, Canada
3School of Nursing, Wuhan University, Wuhan, Hubei Province, China
4School of Nursing, Hangzhou Normal University, Hangzhou, China
5Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
6Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy

Background:

Clinical practice guidelines include clear, detailed, and actionable recommendations, however in addition to these, other types of statements are also included. Currently one study, has proposed a framework for classifying recommendations in guidelines which can assist guideline developers in creating actionable statements with clear intent and avoiding informal recommendations.

Objectives:

The purpose of this study is to validate this framework using Chinese guidelines and identify the formal recommendations.

Study Design and Setting: We searched five databases, including CNKI, WanFang database, VIP, SinoMed and PubMed, with the aim of identifying the clinical practice guidelines from January 1, 2020 to May 1, 2023. The study selection and data extraction were conducted by five independent researchers. The inter-rater reliability was assessed using the Fleiss' Kappa statistics.

Results:

We included 116 guidelines, including 75 Western Medicine guidelines, 13 Traditional Chinese Medicine guidelines, and 28 integrated Chinese and Western Medicine guidelines. Ninety-nine guidelines (85.3%) utilized the GRADE criteria. The biggest number of guidelines (53.4%) were developed by the medical specialty societies. A total of 4422 statements were extracted from these guidelines. Among them, 2154 (48.7%) were formal recommendation, 197 (4.4%) were good practice statements, 394 (8.9%) were remarks, 16 (0.4%) were research only recommendations, 1106 (25%) were implementation considerations, tools and tips, and 555 (12.6%) were informal recommendation.

Conclusion:

Currently, the quality of clinical practice guidelines in China needs to be further improved. We suggest the following initiatives including 1) Providing clear evidence to support the recommendation and stating the reasons for the recommendation underneath them; 2) Providing clear grading of evidence and strength of recommendation; 3) Providing clear statements of clinical problems and clear and actionable recommendations; And 4) Providing clear methodological content to ensure clarity, specificity, and transparency in the guidance development process.