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TRUST or BUST

Guideline comparison

Below, we have applied the simplified G-TRUST to Canadian preventive care guidelines. Domains assessed are confidence, interpretation and relevance. A quality/trustworthy score of green checkmarks suggests a quality guideline that should be considered for eligible patients. Otherwise, a more detailed appraisal is warranted.

Simplified G-TRUST: cfp.ca/content/cfp/70/6/372.full.pdf

DomainKey QuestionPrompts
ConfidenceWhat is the factual basis of the recommendations, and is this transparent in the guideline?
  • Is a systematic review available?
  • Were GRADE or another rigorous methods used?
InterpretationDo I trust the people who interpreted the evidence and made the recommendations?
  • Are the guidelines free of competing interests (financial, intellectual)?
  • Have conflicts of interest been managed?
  • Are the panel members diverse?
RelevanceIs this guideline useful and applicable in my practice?
  • Are the patients, population, and context similar to mine?
  • Do the guidelines address patient-oriented outcomes?
  • Are the recommendations clear and actionable?
  • Has time needed to treat/feasibility been considered?

24 topics shown

Chronic disease screening

Hypertension

Confidence
  • With no quantitative information on harms/benefits of the proposed interventions, it is unclear how evidence relates to the recommendations
  • ADAPTE and GRADE methods partially used
Interpretation
Relevance
  • No information on harms/benefits in absolute numbers
  • No patient-oriented outcomes
  • Outcomes inconsistently presented
  • Surrogate outcomes (e.g., BP targets) that do not clearly provide magnitude of effect
  • Values and preferences described those of the guideline committee toward their recommendation (not from a patient perspective)
Confidence
  • No concerns
Interpretation
  • No concerns
Relevance
  • Dated: evidence may have evolved

Chronic disease screening

Lipids

Confidence
Interpretation
  • No concerns
Relevance
  • No concerns
Confidence
  • No systematic review
Interpretation
Relevance
  • No patient-oriented outcomes
  • Outcomes inconsistently presented
  • No absolute numbers
  • Surrogate outcomes (e.g., blood test levels) that do not clearly provide magnitude of effect
  • No feasibility, opportunity costs, time needed to screen/treat

Chronic disease screening

Diabetes screening in adults

Confidence
  • No systematic review
  • No GRADE
Interpretation
  • Panel limited to specialists (endocrinologists); no family medicine on panel
  • 1 author declared industry-related COI
  • 2 authors found to declare industry-related COI on other manuscripts (see: [1], [2], [3])
  • Funders have industry COI
Relevance
  • No information on harms/benefits in absolute numbers
  • Patient-important outcomes not defined nor presented
  • No tools
  • No feasibility, opportunity costs, time needed to screen/treat
Confidence
  • No concerns
Interpretation
  • 1 author with competing interest said to have been addressed, but unclear what was done
Relevance
  • Dated: evidence may have evolved

Chronic disease screening

Abdominal aortic aneurysm (AAA)

Confidence
  • No systematic review
  • GRADE partially used
Interpretation
Relevance
  • No information on harms/benefits in absolute numbers
  • Outcomes inconsistently presented
  • Missing important patient-oriented outcomes
  • No tools
  • No feasibility, opportunity costs, time needed to screen/treat
Confidence
  • No concerns
Interpretation
  • No concerns
Relevance
  • No concerns

Chronic disease screening

Prevention of fragility fracture (osteoporosis)

Confidence
  • No systematic review
  • GRADE partially used
Interpretation
  • Financial COI limited to one year before and during the guideline development
  • COI managed
  • Chair of the COI Oversight Committee declared financial COI
  • Funders have industry COI
Relevance
  • No information on harms/benefits in absolute numbers
  • Missing key patient-oriented outcomes (e.g., no overdiagnosis)
  • Used surrogate outcomes (e.g., bone density results)
  • No tools for shared decision-making
Confidence
Interpretation
  • No concerns
Relevance
  • No concerns

Chronic disease screening

Screening for inappropriate prescribing in older persons

Confidence
  • No systematic review available (provided documents meet standards for systematic reviews)
  • Unclear how GRADE was applied
Interpretation
  • 1 co-lead is co-owner of for-profit business impacted by guideline
  • Management of COI is vague
Relevance
  • No information on harms/benefits in absolute numbers
  • No tools (other than intervention tools)
  • No opportunity costs; relies on additional dedicated funding

Cancer screening

Cervical cancer

Confidence
  • No concerns
Interpretation
  • No concerns
Relevance
  • Information on harms/benefits in absolute numbers difficult to find and inconsistently presented
  • Dated — more recent trials are now available on screening with HPV tests

Cancer screening

Colorectal cancer

Confidence
  • No concerns
Interpretation
  • No concerns
Relevance
  • Information on harms/benefits in absolute numbers difficult to find and inconsistently presented
  • Dated — recent trials now available on screening with colonoscopy

Cancer screening

Prostate cancer

Confidence
  • No systematic review
  • Unclear how evidence used (Oxford Levels of Evidence)
Interpretation
  • Panel limited to specialists (urologists); no family medicine on panel
  • 4/8 with financial COI
  • Funders have industry COI
Relevance
  • No information on harms/benefits in absolute numbers
  • Outcomes inconsistently presented
  • No tools
  • No feasibility, opportunity costs, time needed to screen/treat
Confidence
  • No concerns
Interpretation
  • No concerns
Relevance
  • Dated: new follow-up studies have since been published

Lifestyle

Tobacco cessation

Confidence
Interpretation
  • No concerns
Relevance
  • No concerns
Confidence
  • No systematic review
  • No GRADE or similar
Interpretation
  • No COI statement
  • Limited primary care involvement (no practicing family physicians, 1 nurse practitioner)
  • Funders have industry ties
Relevance
  • No clear recommendations
  • No information on harms
  • No feasibility, opportunity costs, time needed to screen & treat

Infectious diseases

Hepatitis C screening in adults

Confidence
  • No concerns
Interpretation
  • No concerns
Relevance
  • Since publication, funding is now available for treatment. Authors had identified this as a contributing factor to their judgement “against” recommendation.

A note on methods

This information is for educational purposes and based on the review of contributors to TRUST MF/FM. Two clinicians reviewed the guidelines according to the simplified G-TRUST to confirm and inform this table. We encourage users to review each guideline and associated documents and confirm details as needed.

Since "time needed to screen" is a newer concept, we considered the criteria "met" if the guidelines described an assessment of feasibility (which may include costs, resources needed, acceptability). For guidelines that did not recommend a new intervention, feasibility was considered "met" if no additional work was required. Many guidelines are from the Canadian Task Force on Preventive Health Care (CTFPHC) given the breadth of topics covered by this group.

Some members of the TRUST group (Guylène Thériault, Donna Reynolds) are former members and authors of guidelines of the Canadian Task Force on Preventive Health Care (CTFPHC).

COI = Conflicts of Interest.