Table 1.

Scaled AGREE II Domain Scores for Each Guideline and Overall Assessment

Variable	ACR	ACS	CTFPHC	MSTF	SIGN	USPSTF
Scaled domain score, %*
Scope and purpose	38	92	96	72	79	92
Stakeholder involvement	11	81	79	18	69	62
Rigor of development	7	77	83	32	65	82
Clarity of presentation	71	88	86	76	67	80
Applicability	4	66	86	24	44	49
Editorial independence	2	33	80	20	77	88
Overall guideline assessment
Average overall assessment (out of 7)†	1.6	5.0	6.4	3.2	4.2	6.0
Would recommend this guideline for use?	5 no	1 yes 4 yes with modifications‡	3 yes 2 yes with modifications§	1 yes 2 yes with modifications∥ 2 no	3 yes with modifications¶ 2 no	2 yes 3 yes with modifications**

ACR = American College of Radiology; ACS = American Cancer Society; AGREE II = Appraisal of Guidelines for Research and Evaluation II; CTFPHC = Canadian Task Force on Preventive Health Care; MSTF = U.S. Multi-Society Task Force on Colorectal Cancer; SIGN = Scottish Intercollegiate Guidelines Network; USPSTF = U.S. Preventive Services Task Force.

^*Calculated as follows: (obtained score − minimum possible score) ÷ (maximum possible score − minimum possible score).

^†Final overall assessment questions on AGREE II.

^‡Individual reviewer suggested modifications: “Solid methods, but overreliance on modeling overestimating benefits. Overreliance on modeling and any [colorectal cancer] mortality reduction despite lack of overall mortality. Minimizes harms info including nothing related to overdiagnosis or overtreatment. Rising incidence indicates very small in absolute terms (2/100,000) and likely at least partially accounted for by detection issues.”

^§Individual reviewer suggested modifications: “Limited access to flex sig/colonoscopy may make this guideline less generalizable to U.S.”

^∥Individual reviewer suggested modifications: “Age to stop and rationale for tier 1 screening that does not include [fecal occult blood testing] is not clear. May involve societal conflicts (all [gastrointestinal]).”

^¶Individual reviewer suggested modifications: “It is vague and does not provide useful implementation for type, who, when, how often. Does not assess harms or costs including opportunity. Little data provided. Scope extends beyond screening, methods for making recommendations weren’t described.”

^**Individual reviewer suggested modifications: “Overreliance on modeling, assumption of 100% adherence in models biases towards greater net benefit. Overreliance on [colorectal cancer] mortality reduction. Little info on advanced cancer incidence. No breakout by sex especially for younger or to look at finer gradation of net benefit by age (findings from [randomized controlled trials] and absolute risk show very little to no net benefit).”