Table 4. Summary of the reviewers’ comments organized by the AGREE II standardized domains on management of SCD in pregnancy CPGs from the ACOG, NHLBI, NICE, and RCOG20-23* Table 4. Summary of the reviewers’ comments organized by the AGREE II standardized domains on management of SCD in pregnancy CPGs from the ACOG, NHLBI, NICE, and RCOG20-23* Table 4. Summary of the reviewers’ comments organized by the AGREE II standardized domains on management of SCD in pregnancy CPGs from the ACOG, NHLBI, NICE, and RCOG20-23*
AGREE II Domain Strengths Limitations
Domain 1. Scope and Purpose
Objectives, purpose, health intent, clinical questions, patient population were clearly mentioned in the CPG full document or the website using the PICO model (NICE, NHLBI, RCOG). Target users were general rather than specific (ACOG)
Domain 2. Stakeholder Involvement
GDG members’ names, specialties, institutions, and geographical locations were clearly mentioned and easy to find. GDG included methodologist(s) (NICE, RCOG). GDG included members from relevant professional groups including patient representatives (NICE) GDG disciplines and roles were not clearly mentioned (ACOG). GDG was missing some key disciplines (e.g. pharmacists and nurses) (RCOG)002E Lack of adequate and clear descriptions of patient participation or preferences and target users (ACOG, NHLBI).
Domain 3. Rigour of development
Detailed evidence search keywords were mentioned (NICE, RCOG). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of evidence was utilized (NICE, NHLBI) Recommendations include health benefits, harms, and side effects of recommendations with or without a discussion of their trade-offs (NICE, NHLBI). All recommendations were linked to their relevant primary source of evidence (NICE, NHLBI, RCOG). Lists and processes of external review were clearly reported and easy to find (NICE, NHLBI, RCOG). Updating was clearly mentioned (NICE, RCOG). Lack of detailed search strategy (ACOG). Strengths and limitations of the body of evidence (evidence tables) were not clearly reported (ACOG). Lack of detailed process for formulation of the recommendations, and discussion of trade-off between harms and benefits (ACOG, RCOG). Details and methods of the external review process and outcomes were not clearly reported (ACOG). Review and update process was not reported (ACOG, NHLBI)
Domain 4. Clarity and presentation
This domain was well-addressed in most included CPGs, where key recommendations were specific, unambiguous, and easily identifiable in all CPGs (NICE, NHLBI, RCOG). Management of SCD Crisis in different pregnancy trimesters and abnormal fetal surveillance management were not highlighted (ACOG).
Domain 5. Applicability
Some facilitators and barriers to implementations and clinical governance issues were discussed (NHLBI, NICE, RCOG). A package of CPG Implementation tools were provided like educational tools (NICE), protocols (NHLBI), summary document (NHLBI, NICE, RCOG), patient information (NHLBI, NICE), clinical algorithm or pathway (NHLBI, NICE), baseline assessment sheet (NICE), Mobile App (RCOG). Quality standards, measures, indicators, and/ or clinical audit criteria were provided (NICE, RCOG). A formal economic analysis was conducted (NICE). Facilitators and barriers to implementations were not explicitly mentioned (ACOG). Implementation tools were not provided (ACOG). Quality measures or key performance indicators were not provided (ACOG, NHLBI). No formal economic analysis was conducted (ACOG, NHLBI, and RCOG).
Domain 6. Editorial independence
Funding with or without an influence statement were mentioned (NICE, NHLBI, RCOG). DCOI statements were clearly provided (NICE, NHLBI, RCOG). Funding and influence statements were not clearly reported (ACOG, NHLBI). No DCOI statements were provided (ACOG).