Methodology

The SCAN workgroups are comprised of panels of oncology professionals from Singapore with special subspecialty interest in the management of specific cancers. Membership of the workgroup was by invitation to both public and private sectors. The workgroup elected its own chairperson and decided on its own scope. Guideline selection was conducted through workgroup consensus. Potential conflicts of interest were declared by the International Committee of Medical Journal Editors (ICMJE) guidelines. Secretarial support for the overall guideline development effort was provided by Annals, Academy of Medicine Singapore. No other financial support was obtained. Guideline searching was conducted by the section lead with input from the workgroup members. The group met once in person, and completed guideline development through email communication.

The ADAPTE framework was used as a pragmatic structure and guidance for calibration of international high quality guidelines to the Singapore context. The framework involves 3 phases: set-up, adaptation and finalisation. During the set-up phase, available resources were considered. During the adaptation phase, specific cancer-related issues of relevance were identified and the scope and distribution of tasks were finalised. High quality guidelines were selected for evaluation and structured approaches developed for guideline evaluation and selection. This involved the extraction of data on source guideline development, the setting up of mechanisms for selecting recommendations and also recognising possible dissent amongst panel members. The guidelines were chosen based on their high quality, currency and applicability to the patient population. Calibration of guidelines to the local context based on available Singapore data was encouraged. The finalisation phase involved writing, external review, stakeholder feedback, and the setting up of a mechanism for regular updating. For each individual recommendation, agreement was established by a simple majority for established international recommendations and by a two-third majority for independent local recommendations. Dissenting workgroup members were invited to include comments for each recommendation. International measures of cost-effectiveness for each recommendation were obtained where available but not used to inform the recommendations.