Assessing the methodologic heterogeneity of Canadian Urological Association guidelines: Adoption of the GRADE approach (2018-2023).

Introduction: The Canadian Urological Association (CUA) has a longstanding tradition of developing evidence-based guidelines. We conducted this study to assess the heterogeneity of the CUA's guideline methodology for developing recommendations from 2018-2023.

Methods: We included guidelines from the CUA website from 2018-2023. Two independent reviewers working independently and in duplicate abstracted all data points and categorized the reported methodologic approaches for formulating recommendations and rating the evidence. We performed descriptive statistics only.

Results: We included 23 guideline documents with a total of 654 recommendations. The median number of recommendations per guideline was 25 (interquartile range 17; 35). Seven guidelines (187 recommendations) used a modified Oxford Center for Evidence-Based Medicine approach for both the strength of recommendations and the levels of evidence, and eight guidelines (177 recommendations) reported the use of GRADE both for the strength of recommendations and the certainty of evidence. Of the remaining eight guidelines, four (154 recommendations) blended the GRADE approach for the strength of recommendations with modified Oxford levels of evidence, and the remaining four combined the American Urological Association's approach to recommendations with Oxford levels of evidence (n=1), GRADE certainty of evidence (n=2), or used GRADE but made no recommendations (n=1).

Conclusions: CUA guidelines have been marked by considerable methodologic heterogeneity that may confuse end users. Continued advancement in the CUA's approach to guideline development will facilitate greater collaboration and resource sharing, thereby supporting the CUA's mission of promoting high-quality, evidence-based care.