Scottish referral guidelines for suspected cancer

Guidelines to support primary care clinicians in identifying patients who are most likely to have cancer and therefore require urgent assessment by a specialist. Equally, they help in identifying patients who are unlikely to have cancer, embedding safety netting as a diagnostic support tool.

Appendix 1: Methodology Used – 2014 Version

The steering group agreed that the starting point for the revision process would be the existing referral guidelines, enhanced by a review of evidence-based recommendations for referral from across the world. These recommendations were identified from a search of the websites for a number of guideline-producing organisations in June 2012. This was supplemented with a search for relevant guidelines in Medline and Embase. The search was updated in January 2013 to ensure that all relevant guidelines were identified. Only guidelines published in English were considered.

All the guidelines identified by the search were appraised for methodological quality using the Appraisal of Guidelines for Research and Evaluation II (AGREEII) instrument. AGREEII is a validated tool used for the assessment of clinical practice guidelines. It consists of 23 items organised into six quality domains that cover separate dimensions of guideline quality. Each guideline is assigned an overall quality rating and a decision regarding whether the guideline would be recommended for practice is also made. Each item is rated on a 7-point scale (1=strongly disagree to 7=strongly agree). An overall summary of recommendations and quality rating for each guideline was compiled into evidence tables which are available at

The groups identified, reviewed and systematically considered differences in recommendations emerging from the guidelines, in the light of their clinical and practical experience as well as their expert knowledge of the literature, while taking account of the Scottish context. Where Scottish Intercollegiate Guidelines Network (SIGN) guidelines are in place or are being revised, effort was made to ensure consistency between these guidelines and the related SIGN guideline.

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