This thesis examines the evidence base on which the NICE guideline for colorectal cancer was developed. The information supporting guidelines varies. Six separate studies researching the availability and quality of different types of such information were carried out. Methodology, epidemiology, clinical practice, diagnostic accuracy, therapeutic, and internationally sourced data was examined. The information was sourced by online data mining, national database queries, systematic reviewing of literature databases, and the observation of the NICE guideline development process through both membership of the guideline development group established to produce the recommendations, and the technical development team supporting its production. Results show that : • NICE methodology data is available publicly, is easily accessible online, and has been developed following an internationally accepted guideline quality assessment and development tool. • Epidemiology data on colorectal cancer is easily accessible and of good quality. • Data regarding current clinical practice on colorectal cancer collected by national databases has methodological challenges and is not easily accessible. • Diagnostic accuracy studies are less robustly developed comapared to therapeutic studies. Their design is heterogeneous making the results subject to bias and reporting is inconsistent. Quality assessment when evaluating diagnostic evidence for a guideline ensures clarity with regard to the strength of the recommendations. • Systematic reviews of therapeutic studies can be inappropriately considered high quality evidence using traditional quality appraisal and evidence classification methods. All outcomes of a study should be considered when assesing study quality and recommendations based on a more holistic grading of the evidence are a more accurate reflection of the evidence. • Evidence considered for guideline development is international in its nature and the national setting of a study does influence guideline recommendations. Overall, NICE methodology is of high quality. The research helps identify challenges that the evidence can present as a platform for future improvements.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:642502 |
| Date | January 2014 |
| Creators | Kontoyannis, Angeliki |
| Publisher | Cardiff University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://orca.cf.ac.uk/71966/ |
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