Quality appraisal of clinical practice guidelines for fertility preservation in patients with breast cancer: a systematic review using AGREE II and AGREE-REX.
4 affiliations
- 1Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China.
- 2Digestive Endoscopy Center, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China.
- 3School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
- 4Department of Interventional Radiology Center, School of Medicine, Xiamen Cardiovascular Hospital of Xiamen University, Fujian Branch of National Clinical Research Center for Cardiovascular Diseases, Xiamen, Fujian, China.
Abstract
Objective
This review utilizes the AGREE II instrument to evaluate the methodological rigor and the AGREE-REX instrument to evaluate the implementability of recommendations within clinical practice guidelines for fertility preservation in patients with breast cancer. This is the first study to comprehensively appraise related guidelines using both officially recognized instruments. The findings aim to inform clinical application by identifying high-quality and implementable guidelines.Methods
By June 2026, a systematic search was conducted across seven electronic databases, six guideline repositories, and relevant breast cancer society websites. Guidelines were screened according to predefined criteria, and independent quality assessments were performed using AGREE II and AGREE-REX. Inter-rater reliability was evaluated via the intraclass correlation coefficient (ICC).Results
Twelve guidelines were included. The AGREE II domain scores (mean standardized percentages) showed significant variations: Scope and Purpose (72.98%), Editorial Independence (71.81%), Clarity of Presentation (70.05%), Applicability (69.33%), Rigor of Development (55.30%), and Stakeholder Involvement (54.78%), highlighting critical gaps in patient participation and evidence updating mechanisms. Based on AGREE II and AGREE-REX evaluations, five guidelines were classified as Grade A (strongly recommended), four as Grade B, and three as Grade C.Conclusion
The five Grade A guidelines predominantly originated from Western countries. Prior to clinical implementation, they require cultural adaptation, language translation, and local validation to align with regional healthcare systems and patient values. Future guideline development should prioritize stakeholder integration, dynamic updating mechanisms, and resource allocation assessments to enhance clinical applicability.Systematic review registration
https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD42023464394.
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BibTeX
@article{yan2026quality,
title = {{Quality appraisal of clinical practice guidelines for fertility preservation in patients with breast cancer: a systematic review using AGREE II and AGREE-REX.}},
author = {Wenjuan Yan and Lili Wang and Hongjuan Zhou and Lili Zhao and Yunfei Zhang},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1930322},
url = {https://europepmc.org/article/MED/42908708},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quality appraisal of clinical practice guidelines for fertility preservation in patients with breast cancer: a systematic review using AGREE II and AGREE-REX.
AU - Wenjuan Yan
AU - Lili Wang
AU - Hongjuan Zhou
AU - Lili Zhao
AU - Yunfei Zhang
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1930322
UR - https://europepmc.org/article/MED/42908708
AB - Objective This review utilizes the AGREE II instrument to evaluate the methodological rigor and the AGREE-REX instrument to evaluate the implementability of recommendations within clinical practice guidelines for fertility preservation in patients with breast cancer. This is the first study to comprehensively appraise related guidelines using both officially recognized instruments. The findings aim to inform clinical application by identifying high-quality and implementable guidelines.Methods By June 2026, a systematic search was conducted across seven electronic databases, six guideline repositories, and relevant breast cancer society websites. Guidelines were screened according to predefined criteria, and independent quality assessments were performed using AGREE II and AGREE-REX. Inter-rater reliability was evaluated via the intraclass correlation coefficient (ICC).Results Twelve guidelines were included. The AGREE II domain scores (mean standardized percentages) showed significant variations: Scope and Purpose (72.98%), Editorial Independence (71.81%), Clarity of Presentation (70.05%), Applicability (69.33%), Rigor of Development (55.30%), and Stakeholder Involvement (54.78%), highlighting critical gaps in patient participation and evidence updating mechanisms. Based on AGREE II and AGREE-REX evaluations, five guidelines were classified as Grade A (strongly recommended), four as Grade B, and three as Grade C.Conclusion The five Grade A guidelines predominantly originated from Western countries. Prior to clinical implementation, they require cultural adaptation, language translation, and local validation to align with regional healthcare systems and patient values. Future guideline development should prioritize stakeholder integration, dynamic updating mechanisms, and resource allocation assessments to enhance clinical applicability.Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD42023464394.
SN - 2296-858X
ER -