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1.3 Identification of scientific evidence

To ensure that the statements made are evidence based, the current literature is reviewed and
critically appraised. A systematic literature review of the studies is carried out by a professional
methodologist using the MEDLINE database. The indexing terms and the date limits are decided
by the Chair and the methodologist.

The literature search is limited to publications in English. Priority is given to high-quality
systematic reviews, meta-analyses, and randomized controlled trials but lower levels of evidence
are also evaluated. The search strategy excludes editorials, letters, and in vitro studies. The
reference list of each identified article is reviewed for other potentially relevant papers. The
bibliography is also be supplemented by additional references provided by the international
development group.

Another bibliographic search is carried out to identify previous initiatives using a systematic
literature search in the MEDLINE database (no restriction in the search period, indexing terms:
clinical practice guidelines, evidence-based medicine, guidelines, methodology,
recommendations) and a bibliographic search using selected websites of other
national/international learned societies or governmental organizations. All retrieved articles are
methodologically and clinically appraised. After the selection and critical appraisal of the articles,
a summary of the scientific evidence is developed.

1.4 Formulation of recommendations

The IDG develops recommendations at the time of a physical meeting. The recommendations are
retained if they are supported by sufficient high level scientific evidence and/or when a large
consensus among experts is obtained. By default, a guideline is the clinical approach that is
unanimously recognized by experts as being the criterion-standard clinical approach. If an
approach is judged to be acceptable but is not unanimously recognized as a criterion-standard
clinical approach, indication is given that it is still subject to discussion and/or evaluation. In the
absence of any clear scientific evidence, judgment was based on the professional experience and
consensus of the development group (expert agreement). The reliability and quality of the
evidence given throughout this document is graded following the SIGN grading system.

1.5 External evaluation of the recommendations - International review

The ESGO office selects a panel of practicing clinicians who provide care to cancer patients and
patients. The objective is to assemble a multidisciplinary panel. The international reviewers are
independent from the development group. Another requirement is a balanced representativity of
countries across Europe. International reviewers are asked to evaluate each recommendation
according to their relevance and feasibility in clinical practice (only physicians). Quantitative and
qualitative evaluations of the recommendations are proposed to be performed. Patients group
representatives are also consulted. The total number of external reviewers is around 100.

1.6 Integration of international reviewers comments

Responses are pooled and discussed by the development group at the time of a second meeting
or email forum. The final recommendations are elaborated. When necessary, a modified Delphi
approach is used to reach consensus.

guidelines.esgo.org | esgo-guidelines@esgomail.org
Published October 2016 by European Society of Gynaecological Oncology

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