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General medicine
Evaluation of the NCCN guidelines using the RIGHT Statement and AGREE-II instrument: a cross-sectional review
  1. Cole Wayant1,
  2. Craig Cooper2,
  3. D’Arcy Turner3,
  4. Matt Vassar2
  1. 1 Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
  2. 2 Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
  3. 3 Medical Education, Kansas City University of Medicine and Biosciences, Kansas City, Kansas, USA
  1. Correspondence to Cole Wayant, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA; cole.wayant{at}


Introduction Robust, clearly reported clinical practice guidelines (CPGs) are essential for evidence-based clinical practice. The Reporting Items for practice Guidelines in HealThcare (RIGHT) Statement and Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument were published to improve the methodological and reporting quality in healthcare CPGs.

Methods We applied the RIGHT Statement checklist and AGREE-II instrument to 48 National Comprehensive Cancer Network (NCCN) guidelines. Our primary objective was to assess the adherence to RIGHT and AGREE-II items. Since neither RIGHT nor AGREE-II can judge the clinical usefulness of a guideline, our study is designed to only focus on the methodological and reporting quality of each guideline.

Results The NCCN guidelines demonstrated notable strengths and weaknesses. For example, RIGHT Statement items 19 (conflicts of interest), 7b (description of subgroups) and 13a (clear, precise recommendations) were fully reported in all guidelines. However, the guidelines inconsistently incorporated patient values and preferences and cost. Regarding the AGREE-II instrument, the NCCN guidelines scored highly on the domains 4 (clear, precise recommendations) and 6 (handling of conflicts of interest), but lowest on domain 2 (inclusion of all relevant stakeholders).

Conclusions In this investigation, we found that NCCN CPGs demonstrate key strengths and weaknesses with respect to the reporting of key items essential to CPGs. We recommend the continued use of NCCN guidelines and improvements to weaknesses in reporting and methods. Doing so serves to improve the evidence delivered to healthcare providers, thus potentially improving patient care.

  • oncology
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  • Contributors CW and MV designed the study. CW, CC and DT extracted and analysed all data. All authors wrote and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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