Evidence-based construction of evaluation items for selecting priority clinical questions of traditional Chinese medicine guidelines_Chinese Journal of Evidence-Based Medicine

Authors：

HU Ziteng ¹ , CHEN Yaxin ^1,2 , ZHANG Haili ¹ , LI Huizhen ¹ , ZHANG Yujing ¹ , LIU Yuqi ¹ , ZHAO Chen ¹ , CAO Wenjie ¹ , WANG Weili ¹ , ZONG Xingyu ¹ , YANG Yijiu ¹ , ZHANG Fuqiang ¹ , WANG Yanping ¹ ,  LIANG Ning ¹ ,  SHI Nannan ¹

1. Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, P. R. China;
2. Amsterdam University Medical Center, Amsterdam 1105AZ, Netherlands;

Corresponding?author：

LIANG Ning, Email: liangning229@163.com; SHI Nannan, Email: 13811839164@vip.126.com

Keywords：

Traditional Chinese medicine; Guideline; Clinical questions; Priority setting

DOI：

10.7507/1672-2531.202404091

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the items affecting the prioritization of clinical questions and to construct an evaluation scale for prioritizing clinical question of traditional Chinese medicine (TCM) guidelines. Methods Literature analysis and cognitive interview were used to construct the pool of items for evaluating the prioritization of clinical questions of TCM guidelines, and Delphi methods was used to identify the items to form the evaluation scale. Results A total of 47 articles were included in this study, and the two rounds of Delphi questionnaires had a recovery rate of 72% and 100%, respectively. The mean value of the importance of the items in the first round ranged from 3.78 to 4.78, with a coefficient of variation ranging from 0.09 to 0.30, and the mean value in the second round ranged from 4.06 to 4.72, with a coefficient of variation ranging from 0.09 to 0.29. The evaluation scale for the prioritization of clinical questions of TCM guidelines (first edition) was constructed, which contains 13 entries in 4 dimensions. Conclusion This study explored the items affecting the prioritization of clinical questions in TCM guidelines and developed a prioritization evaluation scale, which improved the lack of objectivity and interpretability of the current prioritization of clinical questions in TCM guidelines to a certain extent, and strengthened the transparency of the process of selecting clinical issues in TCM guidelines.

Citation： HU Ziteng, CHEN Yaxin, ZHANG Haili, LI Huizhen, ZHANG Yujing, LIU Yuqi, ZHAO Chen, CAO Wenjie, WANG Weili, ZONG Xingyu, YANG Yijiu, ZHANG Fuqiang, WANG Yanping, LIANG Ning, SHI Nannan. Evidence-based construction of evaluation items for selecting priority clinical questions of traditional Chinese medicine guidelines. Chinese Journal of Evidence-Based Medicine, 2025, 25(2): 134-140. doi: 10.7507/1672-2531.202404091 Copy

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9.	方振威, 石秀錦, 周鵬翔, 等. 《P2Y_(12)受體拮抗劑用于急性冠狀動脈綜合征或經皮冠狀動脈介入治療患者精準治療快速建議指南》臨床問題與結局指標的確定. 臨床藥物治療雜志, 2021, 19(7): 37-42.
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38.	Mounesan L, Sayarifard A, Haghjou L, et al. A manual for prioritizing the topics of clinical practice guidelines for family physicians. Int J Prev Med, 2016, 7: 64.
39.	Becker M, Jaschinski T, Eikermann M, et al. A systematic decision-making process on the need for updating clinical practice guidelines proved to be feasible in a pilot study. J Clin Epidemiol, 2018, 96: 101-109.
40.	Borgonjen RJ, van Everdingen JJ, van de Kerkhof PC, et al. Prioritizing dermatoses: rationally selecting guideline topics. J Eur Acad Dermatol Venereol, 2015, 29(8): 1636-1640.
41.	Jo HS, Kim DI, Oh MK. National priority setting of clinical practice guidelines development for chronic disease management. J Korean Med Sci, 2015, 30(12): 1733-1742.
42.	Loeffen EA, Mulder RL, Kremer LC, et al. Development of clinical practice guidelines for supportive care in childhood cancer--prioritization of topics using a Delphi approach. Support Care Cancer, 2015, 23(7): 1987-1995.
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46.	康曉鳳, 呂蓉, 張方圓, 等. 《成人急性心力衰竭護理實踐指南》優先主題的確定. 中國護理管理, 2016, 16(9): 1191-1195.
47.	老膺榮. 對中醫及中西醫結合臨床治療指南制訂中幾個重要環節的思考. 中國中西醫結合雜志, 2010, 30(3): 237-240.
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55.	楊思紅, 陳可冀, 劉建平, 等. 中醫藥臨床實踐指南從證據到推薦意見形成要目和解讀. 中國中西醫結合雜志, 2021, 41(4): 494-498.
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1. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical practice guidelines we can trust. Washington (DC): National Academies Press (US), 2011.
2. World Health Organization. WHO handbook for guideline development (2nd ed). Geneva: World Health Organization, 2014.
3. National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. London: National Institute for Health and Care Excellence (NICE), 2015.
4. SIGN. A guideline developer’s handbook. Edinburgh: SIGN, 2015.
5. Department of Health (DOH), National Clinical Effectiveness Committee (NCEC). How to develop a national clinical guideline: a manual for guideline developers. Dublin: Department of Health (DoH), 2019.
6. Department of Health-Philippines, Philippine Health Insurance Corporation. Manual for clinical practice guideline development. Philippine: Department of Health Philippines, 2018.
7. 倪小佳, 陳耀龍, 蔡業峰. 中西醫結合腦卒中循證實踐指南(2019). 中國循證醫學雜志, 2020, 20(8): 901-912.
8. 田丹, 錢序, 韓鵬, 等. 公共衛生基本項目優先重點評價指標的建立. 中國初級衛生保健, 2010, 24(11): 65-67.
9. 方振威, 石秀錦, 周鵬翔, 等. 《P2Y_(12)受體拮抗劑用于急性冠狀動脈綜合征或經皮冠狀動脈介入治療患者精準治療快速建議指南》臨床問題與結局指標的確定. 臨床藥物治療雜志, 2021, 19(7): 37-42.
10. Wiercioch W, Nieuwlaat R, Zhang Y, et al. New methods facilitated the process of prioritizing questions and health outcomes in guideline development. J Clin Epidemiol, 2022, 143: 91-104.
11. Sanabria AJ, Pardo-Hernandez H, Ballesteros M, et al. The UpPriority tool was developed to guide the prioritization of clinical guideline questions for updating. J Clin Epidemiol, 2020, 126: 80-92.
12. 陳耀龍, 劉蕭, 王燕平, 等. 西醫指南與中醫藥指南: 在相互學習中共同提高. 協和醫學雜志, 2020, 11(5): 615-620.
13. Willis G. Cognitive interviewing: a tool for improving questionnaire design. Thousand Oaks, Calif. : Sage Publications, 2004.
14. KDIGO. KDIGO methods manual for guideline development. Washington (DC): KDIGO, 2022.
15. Gupta S, Bhattacharyya OK, Brouwers MC, et al. Canadian thoracic society: presenting a new process for clinical practice guideline production. Can Respir J, 2009, 16(6): e62-e68.
16. 陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022版). 中華醫學雜志, 2022, 102(10): 697-703.
17. The Saudi Center for Evidence Based Health Care. Saudi Arabian handbook for healthcare guideline development, Version 1.0. Saudi Arabia: The Saudi Center for Evidence Based Health Care, 2014.
18. Agbassi C, Messersmith H, McNair S, et al. Priority-based initiative for updating existing evidence-based clinical practice guidelines: the results of two iterations. J Clin Epidemiol, 2014, 67(12): 1335-1342.
19. Amos Q, Chan W, Tom G. Maximising efficiency in updating guidelines through prioritisation of clinical questions. BMJ Qual Saf, 2013, 22(Suppl 1): A19.
20. Chang S. When to update, when to Archive? The AHRQ EPC program. Quebec: Updating Cochrane Reviews Workshop, 2014.
21. Jamshidi A, Lamontagne M, Ait-Kadi D, et al. Developing a comprehensive priority-based framework for updating clinical practice guidelines (CPGs): a systematic review and international survey. Quebec: Huitieme Colloque Etudiant du CIRRIS, 2016.
22. Jordan-Cole V, Farquhar C, Brown J, et al. Centralised updating officer pilot project: a project of the Cochrane Collaboration final report: August 2008. 2008.
23. Salzwedel D, Wright J. Citation rates of systematic reviews of inter ventions for hypertension and blood pressure. In: Bero L, Montgomery P, Robinson K, et al, editors. Bringing evidence-based decision-making to new heights. Abstracts of the 2010 Joint Colloquium of the Cochrane and Campbell Collabo rations. Keystone: John Wiley & Sons, 2010.
24. Soll RF. Updating reviews: the experience of the Cochrane Neonatal Review Group. Paediatr Perinat Epidemiol, 2008, 22(Suppl 1): 29-32.
25. Takwoingi Y, Hopewell S, Tovey D, et al. A multicomponent decision tool for prioritising the updating of systematic reviews. BMJ, 2013, 347: f7191.
26. Theobald S, Blanc-Vincent Mp, Farsi F, et al. The identification of questions in the updating process of clinical practice guidelines for oncology. Edinburgh: 15th Annual Meeting of the International Society of Technology Assessment in Health Care, 1999.
27. Venhorst K, Ploegmakers M, Holtus A, et al. What isneeded to realize a dynamic process of guideline updating. Melbourne: 11th G-I-N Conference, 2014.
28. Welsh E, Stovold E, Karner C, et al. Cochrane airways group reviews were prioritized for updating using a pragmatic approach. J Clin Epidemiol, 2015, 68(3): 341-346.
29. Battista RN, Hodge MJ. Setting priorities and selecting topics for clinical practice guidelines. CMAJ, 1995, 153(9): 1233-1237.
30. Schünemann HJ, Wiercioch W, Etxeandia I, et al. Guidelines 2. 0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ, 2014, 186(3): E123-E142.
31. Institute of Medicine (US) Committee on Methods for Setting Priorities for Guidelines Development. Setting priorities for clinical practice guidelines. Washington (DC): National Academies Press (US), 1995.
32. McClarey M, Duff L. Identifying priorities for national clinical guidelines. Nurs Stand, 1999, 13(41): 37-41.
33. Oxman AD, Schünemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 2. Priority setting. Health Res Policy Syst, 2006, 4: 14.
34. Ketola E, Toropainen E, Kaila M, et al. Prioritizing guideline topics: development and evaluation of a practical tool. J Eval Clin Pract, 2007, 13(4): 627-631.
35. Reveiz L, Tellez DR, Castillo JS, et al. Prioritization strategies in clinical practice guidelines development: a pilot study. Health Res Policy Syst, 2010, 8: 7.
36. Atkins D, Perez-Padilla R, Macnee W, et al. Priority setting in guideline development: article 2 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report. Proc Am Thorac Soc, 2012, 9(5): 225-228.
37. Reddy BP, Kelly MP, Thokala P, et al. Prioritising public health guidance topics in the National Institute for Health and Care Excellence using the analytic hierarchy process. Public Health, 2014, 128(10): 896-903.
38. Mounesan L, Sayarifard A, Haghjou L, et al. A manual for prioritizing the topics of clinical practice guidelines for family physicians. Int J Prev Med, 2016, 7: 64.
39. Becker M, Jaschinski T, Eikermann M, et al. A systematic decision-making process on the need for updating clinical practice guidelines proved to be feasible in a pilot study. J Clin Epidemiol, 2018, 96: 101-109.
40. Borgonjen RJ, van Everdingen JJ, van de Kerkhof PC, et al. Prioritizing dermatoses: rationally selecting guideline topics. J Eur Acad Dermatol Venereol, 2015, 29(8): 1636-1640.
41. Jo HS, Kim DI, Oh MK. National priority setting of clinical practice guidelines development for chronic disease management. J Korean Med Sci, 2015, 30(12): 1733-1742.
42. Loeffen EA, Mulder RL, Kremer LC, et al. Development of clinical practice guidelines for supportive care in childhood cancer--prioritization of topics using a Delphi approach. Support Care Cancer, 2015, 23(7): 1987-1995.
43. van der Veer SN, van Biesen W, Bernaert P, et al. Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults. Int Urol Nephrol, 2016, 48(6): 859-869.
44. Aleksovska K, Bassetti CLA, Berger T, et al. Prioritization process for European Academy of Neurology clinical practice guidelines. Eur J Neurol, 2023, 30(2): 305-320.
45. Shekelle PG, Motala A, Johnsen B. Assessment of a method to detect signals for updating systematic reviews. Rockville (MD): Agency for Healthcare Research and Quality (US), 2014.
46. 康曉鳳, 呂蓉, 張方圓, 等. 《成人急性心力衰竭護理實踐指南》優先主題的確定. 中國護理管理, 2016, 16(9): 1191-1195.
47. 老膺榮. 對中醫及中西醫結合臨床治療指南制訂中幾個重要環節的思考. 中國中西醫結合雜志, 2010, 30(3): 237-240.
48. 郝云霞, 李慶印, 秦培培, 等. 急診經皮冠狀動脈介入治療護理實踐指南優先主題與結局指標的確定. 中國護理管理, 2019, 19(7): 996-999.
49. 靳英輝, 韓斐, 王強, 等. 臨床實踐指南制訂方法—指南范圍、主題及問題的確定. 中國循證心血管醫學雜志, 2018, 10(3): 257-261.
50. 楊穎, 畢穎斐, 王賢良, 等. 《中成藥治療冠心病臨床應用指南》臨床問題的構建. 中醫雜志, 2021, 62(18): 1582-1587.
51. 李小科, 葉永安, 杜宏波. 基于2015年版慢性乙型肝炎防治指南談中醫藥治療的機遇與挑戰. 世界中醫藥, 2016, 11(2): 364-367.
52. 陳浩, 史大卓. 近年臨床試驗及指南對中西醫結合治療冠心病的啟示. 中西醫結合心腦血管病雜志, 2009, 7(4): 379-381.
53. 卞立群, 陳婷, 程薈蓉, 等. 消化系統中成藥應用指南的編制問題解析. 中國中西醫結合雜志, 2020, 40(5): 620-623.
54. 陳薇, 劉建平. 中西醫結合臨床實踐指南制訂原則和流程. 中國中西醫結合雜志, 2022, 42(12): 1413-1417.
55. 楊思紅, 陳可冀, 劉建平, 等. 中醫藥臨床實踐指南從證據到推薦意見形成要目和解讀. 中國中西醫結合雜志, 2021, 41(4): 494-498.
56. 徐浩, 董紅軍, 陳旭青, 等. 《中醫治未病實踐指南·鼻鼽》臨床一致性評價研究. 中國中醫藥信息雜志, 2018, 25(3): 16-18.
57. 高一城, 劉芷含, 夏如玉, 等. 中醫藥臨床實踐指南臨床問題構建中干預措施的優先性選擇—基于專家證據的方法學建議. 中國循證醫學雜志, 2023, 23(4): 433-438.
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Chinese Journal of Evidence-Based Medicine

Evidence-based construction of evaluation items for selecting priority clinical questions of traditional Chinese medicine guidelines

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