Appraisal of International Guidelines on Smoking Cessation using the AGREE II Assessment Tool

Abstract

Aims Several international professional bodies have produced and disseminated clinical practice guidelines (CPGs) for smoking cessation. However, to date, the quality of guidelines for use in the Irish context has never been appraised and explored. The aim of this study was to identify and evaluate the quality of methodological rigours and transparency used in guidelines for smoking cessation (for speci􀂡c groups including: general adult population; persons with mental illness; and pregnant women). Methods The research for the relevant smoking cessation guidelines was conducted using a systematic search strategy of scienti􀂡c databases (including guideline websites; PubMed; and Google ®) from January 2006 to June 2017. The quality of the CPGs was independently assessed by at least two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, and speci􀂡c recommendations in guidelines were evaluated. Domain scores were considered of su􀂣cient quality when ≥ 60% and of good quality when ≥ 80%. Results Nine guidelines were retrieved. Five guidelines scored ≥ 60% in at least four domains. The median score for the scope and purpose domain was 80% (Range: 61 to 94%). The median score for the stakeholder involvement domain was 63% (Range: 26 to 85%), and six guidelines scored ≥ 60%. The median score for the rigour of development domain was 39% (Range: 23 to 77%), and four guidelines scored ≥ 60%. The median score for clarity of presentation domain was 89% (Range: 56 to 96%), and eight guidelines scored ≥ 60%. The median score the applicability domain was 39% (Range: 21 to 57%). None of guidelines scored ≥ 60%. The median score for the editorial independence domain was 78% (Range: 0 to 90%); only seven guidelines scored ≥ 60%. Conclusions Smoking cessation guideline quality assessment varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Our 􀂡ndings have demonstrated higher scores among the most recent guidelines, re􀂢ecting improvement in the quality of guideline development over time. Methodology and editorial independence were particular concerns and this assessment also highlighted a need for contextualisation to the Irish healthcare system. In conclusion, the plan for Ireland is to adapt rather than simply adopt existing guidelines.