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      Reducing pain in children with cancer: Methodology for the development of a clinical practice guideline

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          Abstract

          Although pain is one of the most prevalent and bothersome symptoms children with cancer experience, evidence‐based guidance regarding assessment and management is lacking. With 44 international, multidisciplinary healthcare professionals and nine patient representatives, we aimed to develop a clinical practice guideline (following GRADE methodology), addressing assessment and pharmacological, psychological, and physical management of tumor‐, treatment‐, and procedure‐related pain in children with cancer. In this paper, we present our thorough methodology for this development, including the challenges we faced and how we approached these. This lays the foundation for our clinical practice guideline, for which there is a high clinical demand.

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

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              GRADE guidelines: 3. Rating the quality of evidence.

              This article introduces the approach of GRADE to rating quality of evidence. GRADE specifies four categories-high, moderate, low, and very low-that are applied to a body of evidence, not to individual studies. In the context of a systematic review, quality reflects our confidence that the estimates of the effect are correct. In the context of recommendations, quality reflects our confidence that the effect estimates are adequate to support a particular recommendation. Randomized trials begin as high-quality evidence, observational studies as low quality. "Quality" as used in GRADE means more than risk of bias and so may also be compromised by imprecision, inconsistency, indirectness of study results, and publication bias. In addition, several factors can increase our confidence in an estimate of effect. GRADE provides a systematic approach for considering and reporting each of these factors. GRADE separates the process of assessing quality of evidence from the process of making recommendations. Judgments about the strength of a recommendation depend on more than just the quality of evidence. Copyright © 2011 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                eah.loeffen@umcg.nl
                Journal
                Pediatr Blood Cancer
                Pediatr Blood Cancer
                10.1002/(ISSN)1545-5017
                PBC
                Pediatric Blood & Cancer
                John Wiley and Sons Inc. (Hoboken )
                1545-5009
                1545-5017
                07 March 2019
                June 2019
                : 66
                : 6 ( doiID: 10.1002/pbc.v66.6 )
                : e27698
                Affiliations
                [ 1 ] University of Groningen University Medical Center Groningen Beatrix Children's Hospital Department of Pediatric Oncology/Hematology Groningen the Netherlands
                [ 2 ] Princess Máxima Center for Pediatric Oncology Utrecht the Netherlands
                [ 3 ] Department of Pediatric Oncology Emma Children's Hospital Academic Medical Center Amsterdam the Netherlands
                [ 4 ] Department of Pharmacy and Research Institute The Hospital for Sick Children Toronto ON Canada
                [ 5 ] Leslie Dan Faculty of Pharmacy University of Toronto Toronto ON Canada
                [ 6 ] Department of Anesthesia and Pain Medicine The Hospital for Sick Children University of Toronto Toronto ON Canada
                Author notes
                [*] [* ] Correspondence

                Erik A.H. Loeffen, Department of Pediatric Oncology/Hematology, University Medical Center Groningen, University of Groningen, Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands.

                Email: eah.loeffen@ 123456umcg.nl

                [†]

                Collaborators of the Pain in Children with Cancer Guideline Development Panel (alphabetical order): Doralina L. Anghelescu (St. Jude Children's Research Hospital, Memphis, TN, USA), Kathryn Birnie (The Hospital for Sick Children, Toronto, ON, Canada), Judith de Bont (University Medical Center Utrecht, Utrecht, the Netherlands), Amy‐Lee Bredlau (Medical University of South Carolina, Charleston, SC, USA), Patsy Cullen (Regis University, Denver, CO, USA), Sarah Daniels (St. Jude Children's Research Hospital, Memphis, TN, USA), Bruce Dick (University of Alberta, Edmonton, AB, Canada), Monique van Dijk (Erasmus MC–Sophia Children's Hospital, Rotterdam, the Netherlands), R. Scott Dingeman (The Johns Hopkins Hospital, Baltimore, MD, USA), Elena Evan (UCLA Health, Los Angeles, CA, USA), Julie Gegg (Boston Children's Hospital, Boston, MA, USA), Faith Gibson (Great Ormond Street Hospital for Children NHS Foundation Trust and University of Surrey, London, UK), Martine van Grotel (Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands), Lindsay Jibb (The Hospital for Sick Children, Toronto, ON, Canada), Roy Kao (UCLA David Geffen School of Medicine, Los Angeles, CA, USA), Rutger Knops (Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands), Ketan Kulkarni (IWK Health Centre, Halifax, NS, Canada), Piet Leroy (Maastricht University Medical Center, Maastricht, the Netherlands), Christina Liossi (University of Southampton, Southampton, UK), Gustaf Ljungman (Uppsala University, Uppsala, Sweden), Jennifer McLean (The Hospital for Sick Children, Toronto, ON, Canada), Maarten Mensink (University Medical Center Utrecht, Utrecht, the Netherlands), Erna Michiels (Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands), Mary Ann Muckaden (Tata Memorial Centre, Mumbai, India), Brittney Newman (St. Jude Children's Research Hospital, Memphis, TN. USA), Karyn Positano (The Hospital for Sick Children, Toronto, ON, Canada), Mienke Rijsdijk (University Medical Center Utrecht, Utrecht, the Netherlands), Emily Rowe (Tufts Medical Center, Boston, MA, USA), Gurjit Sangha (Trillium Health Partners, Mississauga, ON, Canada), Jennifer Stinson (The Hospital for Sick Children, Toronto, ON, Canada), Anna Taddio (University of Toronto, Toronto, Canada), Hannah Taylor (St. Jude Children's Research Hospital, Memphis, TN. USA), Perri Tutelman (Centre for Pediatric Pain Research, Pediatrics, Dalhousie University, NS, Canada), Alison Twycross (London South Bank University, London, UK), Marc Wijnen (Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands), Lonnie Zeltzer (UCLA Health, Los Angeles, CA, USA)

                Author information
                https://orcid.org/0000-0003-4514-3358
                https://orcid.org/0000-0002-7699-1061
                Article
                PBC27698
                10.1002/pbc.27698
                9286396
                30848078
                962c5dbc-caa9-4ce6-8792-1c21a719aee0
                © 2019 The Authors. Pediatric Blood & Cancer Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 21 February 2019
                : 05 December 2018
                : 24 February 2019
                Page count
                Figures: 3, Tables: 1, Pages: 12, Words: 8132
                Funding
                Funded by: KWF Kankerbestrijding , doi 10.13039/501100004622;
                Award ID: RUG 2013‐6345
                Categories
                Clinical Practice Guidelines
                Clinical Practice Guidelines
                Custom metadata
                2.0
                June 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:15.07.2022

                Pediatrics
                clinical practice guideline,evidence‐based medicine,pain,pediatric oncology,supportive care

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