Table 1:

Clinical practice guideline methodology: AGREE II checklist21^,23^,24

AGREE II checklist item	Reporting criteria	Planned guideline protocol
Domain 1: Scope and purpose
1. Guideline objectives	Health intent, expected benefit, targets	To provide information and recommendations for women and their physicians when making decisions about diagnosis, prevention and risk reduction, management and outcomes related to BCRL
2. Questions	Target population Interventions or exposures Outcomes Context	Women with breast cancer with or at risk of developing lymphedema Diagnosis, risk reduction, management and outcomes Improve the care of women with BCRL; focus on self-management Canadian health care system
3. Population	Target population Clinical condition Severity of disease	Adult women with breast cancer^* Breast cancer — from diagnosis to palliative stages Lymphedema — all stages and severity of the condition
Domain 2: Stakeholder involvement
4. Group membership	Participants Membership expertise Institutions and organizations Geographic location Members’ roles	Steering committee, management team and working groups: researchers, clinicians, specialist and patient representatives from across Canada Partners: Canadian Physiotherapy Association Oncology Division, CancerControl Alberta’s Guideline Resource Unit and the Canadian Lymphedema Framework Member roles will be defined and shared
5. Target population preferences and views	Patients’ views and preferences	Patient representatives will be involved at all stages of guideline development Literature review of patients’ values and preferences Survey, focus groups and consultation with patient groups
6. Target users	Intended audience Use of guideline	Physicians as well as women with and at risk of BCRL Inform clinical decisions and standards of care
Domain 3: Rigour of development
7. Search methods	Electronic databases Time periods of searches Search strategy	MEDLINE, Embase, Scopus, CINAHL, Proquest Dissertations and Theses Global, PEDro, Cochrane Library, Trip Pro, Agency for Healthcare Research and Quality’s National Guideline Clearinghouse Guidelines and systematic reviews: Mar. 1, 2014, to Oct. 31, 2021; RCTs: Mar. 1, 2014, to Oct. 31, 2021 Further details on the search terms and strategy are provided in Appendix 1 (available at www.cmajopen.ca/content/10/2/E338/suppl/DC1)
8. Evidence selection criteria	Target population Study design Outcomes Languages	Women with BCRL CPGs; systematic reviews; cross-sectional studies (diagnosis); cohort studies (prognosis); RCTs (treatment and management) Diagnosis and assessment; risk reduction and prevention; management and treatment; outcomes and surveillance No language restrictions
9. Strengths and limitations of evidence	Study methodology to evaluate quality	CPGs: AGREE II appraisal; systematic reviews: AMSTAR; cross-sectional studies: AXIS; cohort studies: Newcastle–Ottawa Scale; RCTs: Cochrane risk-of-bias tool Rating of evidence: tables reflecting GRADE and detailing the level of evidence, consistency of results, direction of results, magnitude of benefit (versus harm) and applicability to practice context in Canada will be developed
10. Formulation of recommendations	Recommendation development process	ADAPTE will be used to incorporate recommendations from existing guidelines Noncontentious findings: steering committee will vote in situations where the level of evidence and the balance between benefits and harms is established, findings are consistent across studies and the recommendation is applicable to the Canadian context Contentious findings or in cases in which there is no evidence: stakeholder consensus on recommendation (best practice statement) or explanation of reasons if consensus cannot be reached
11. Consideration of health benefits, side effects and risks	Data supporting benefits, harms and side effects, and balance of benefits and harms	Tables will be developed to outline the benefits and risks Recommendations will consider the balance between benefits and risks as appropriate
12. Link between recommendations and evidence	Link between evidence and recommendations is explicit	The recommendations will be supported by the level of evidence, the extent of the evidence (total number of studies and total number of subjects), the direction of effect and the magnitude of effect and, where possible, consideration will be given to the stage and severity of lymphedema
13. External review	Participants, purpose and intent of external review	Feedback from external experts and stakeholder groups will be solicited to improve the CPG quality and to obtain feedback on the draft recommendations
14. Updating procedure	Statement on when the guideline will be updated	The steering committee will determine the timeline and outline criteria for future updates
Domain 4: Clarity of presentation
15. Specific and unambiguous recommendations	Recommendations are specific with circumstances and relevant populations identified	Recommendations will be presented with a clear purpose and in an actionable statement format Areas of uncertainty and those requiring further research will be identified A lay summary of the findings will be shared with stakeholder groups
16. Management options	Possible management options are clearly described	Management options will be articulated given the Canadian health care context, and the focus on self-management of lymphedema
17. Identifiable key recommendations	Key recommendations are easily identifiable	Key recommendations will be highlighted in an executive summary Algorithms and flow charts will be created to highlight findings
Domain 5: Applicability
18. Facilitators and barriers to application	Facilitators and barriers to the guideline’s application are described	Information on barriers and facilitators to the CPG will be sought at the draft CPG stage The CPG will be evaluated in Alberta, Canada, before national implementation
19. Implementation advice and tools	Tools to support application of the guideline	Materials will be created to support CPG implementation Short videos will be created for health care professionals and patients; videos will be housed on the Oncology Division of the Canadian Physiotherapy Association and Canadian Lymphedema Framework websites
20. Resource implications	Potential resource implications of recommendations	Where possible, costs related to diagnosis and management will be collected Costs will be considered within the Canadian context
21. Monitoring and auditing criteria	Provide auditing criteria	Operational definitions will be determined to inform auditing and measurement of impact
Domain 6: Editorial independence
22. Funding body	Influence of funding body on guideline recommendations	Initial funding for the stakeholders meeting was received from the Oncology Division of the Canadian Physiotherapy Association The CPG will be completed without influence from any funding body
23. Competing interests	All group members must declare competing interests	All CPG steering committee, management team and working group members will be required to provide written documentation declaring any competing interests People associated with industry or private businesses or who declare other competing interests that could influence the guideline process or development will not be eligible to participate

Note: AGREE II = Appraisal of Guidelines for Research and Evaluation II, AMSTAR = A Measurement Tool to Assess Systematic Reviews, AXIS = Appraisal Tool for Cross-Sectional Studies, BCRL = breast cancer–related lymphedema, CPG = clinical practice guideline, GRADE = Grading of Recommendations Assessment, Development and Evaluation, RCT = randomized controlled trial.
↵* Physicians are the target users in this domain.