Page 7 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)

LEVELS OF EVIDENCE
Level Study design
I Properly powered and conducted randomised controlled
trial; well-conducted systematic review or meta-analysis of
homogeneous randomised controlled trials

II-1 Well-designed controlled trial without randomisation
II-2 Well-designed cohort or case-control analysis study

II-3 Multiple time series, with or without the intervention; results
from uncontrolled studies that yield results of large magnitude

III Opinions of respected authorities, based on clinical experience;
descriptive studies or case reports; reports of expert committees

SOURCE: U.S. Preventive Services Task Force. U.S. Preventive Services Task Force Procedure
Manual. Rockville, MD: USPSTF; 2015.

FORMULATION OF RECOMMENDATION
• In line with the new development in CPG methodology, the
CPG Unit of MaHTAS is adapting Grading Recommendations,
Assessment, Development and Evaluation (GRADE) in its
work process. The quality of body of evidence and related effect
size are carefully assessed/reviewed by the CPG Development
Group (DG).
• Recommendations are formulated based on certainty of
evidence and the wording used denotes the strength of
recommendations. This takes into account:
{ quality and level of the evidence
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{ patient’s preference and values
{ resource implications
{ relevancy and applicability to the local target population
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leading to strong recommendations using the word “should”
being considered. Otherwise, weak recommendations use the
word “may” in proposing an action to be made.
• In the CPG, a yellow box highlights important message(s) in
the management while a blue box contains evidence-based
recommendation(s) for the particular condition.

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