Discussant: Prioritizing Evidence Syntheses
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The document discusses principles for prioritizing evidence syntheses and making them more useful for decision makers. It emphasizes the importance of reviews being relevant, reliable, and readable. Reviews need to consider context and answer questions relevant to end users. Realist reviews can help understand how complex interventions work in different contexts. Rapid reviews are also important to meet timely decision making needs. Reviews must be methodologically rigorous. They should be presented in accessible formats and highlight information useful for decision making, like costs and applicability to local contexts.
Discussant: Prioritizing Evidence Syntheses
- 1. Prioritizing Evidence Syntheses Sharon E. Straus MD MSc FRCPC Canada Research Chair Knowledge Translation and Quality of Care
- 2. Declaration of Competing Interests Associate Editor for ACP JC, EBM Journal Senior Editor, CMAJ On Advisory Board for BMJ Publishing
- 5. Principles of the Program F easibility O bjectivity R esponsiveness E fficiency C onsistency A ccountability S cientific Rigour T ransparency
- 6. The ‘3 Rs’ of Evidence Synthesis Relevant Reliable Readable
- 7. The ‘3 Rs’: Relevant Reviews should be relevant to the needs of the end users Different types of systematic reviews Rapid reviews
- 8. Relevant: Types of reviews Most traditional systematic reviews of interventions don’t consider context With consideration of complex interventions, context is particularly important Most reviews address question of does this intervention work
- 9. Types of reviews What about questions like: Why do school meals programs work in one setting but not in another setting? What factors influence career choice in academic medicine? What factors determine adherence to TB therapy?
- 10. Types of reviews Realist reviews How do complex programs/interventions work in certain contexts or settings? Methods are iterative and aimed to synthesize data to achieve a theory about how, why, in what circumstances a complex intervention may work Realist review to understand the efficacy of school feeding program. BMJ 2007;335:858-61 Meta-ethnography BMC Res Method 2008;8:21 Meta-narrative reviews Milbank Q 2004;82
- 11. Relevant: Rapid reviews Decision makers often have need for timely reviews Producers of evidence syntheses have to balance need for speed with requirement for rigor
- 12. The ‘3 Rs’: Reliable Producers of evidence syntheses must ensure that the evidence is valid and the methods for its generation are explicit and rigorous We need to advance the science of doing different types of systematic reviews and enhance capacity in these areas
- 13. The ‘3 Rs’: Readable Systematic reviews aren’t being used consistently in decision making by: Health care providers including physicians and nurses Int J Med Inform 2003;71:9-15; J Nurs Scholarship 2004;36:220-5 Public health decision makers Int J Technol Assess Health Care 2004;20:399-404 Policy makers Milbank Q 2002;80:125-54; Lancet 2007;369:1883-9 Several factors may influence their use including lack of contextualization and inadequate format of presentation
- 14. Readable Lack of detail about the intervention, its accessibility and risk of adverse events in many systematic reviews Shepperd and Glasziou: less than 20% of systematic reviews published in EBMJ contained an adequate description of the intervention Lavis and colleagues: health care managers and policy makers would benefit from having information that is relevant for decisions highlighted including contextual factors that affect a review’s local applicability and information about costs
- 15. Readable Reviews need to be presented in user friendly formats that facilitate uptake at policy meetings and in clinics We need to advance the science about how reviews should be formatted to enhance uptake ‘ more informative abstracts’ 1 study looking at traditional narrative review vs. Cochrane review Can J Gastroenterol 2002;16:17-21
- 16. Knowledge Translation Canada Its aims are to develop a transformative research program to improve the health of Canadians and to strengthen the Canadian health care system by: Creating new knowledge about how best to achieve KT across different decision maker groups; Advancing the theory and methods of KT; Developing, testing, and commercialising tools and services aimed at sustaining KT; Working with partners across the continuum of care to effect KT; and, Enhancing capacity in this field.
- 17. KT Canada Will focus on targeting 3 stakeholder groups and 4 interlinked research programs: Knowledge distillation Determinants of knowledge use Selecting, tailoring and evaluating effectiveness and efficiency of KT interventions, and Sustaining KT
- 18. Knowledge Distillation Improve uptake of reporting guidelines such as CONSORT (Moher, Grimshaw, Straus) Identify barriers and facilitators to adoption of reporting guidelines by health care journals Design and test a strategy to improve their uptake
- 19. Knowledge Distillation Efficient updating of evidence-based resources (Haynes, Moher) To identify barriers and facilitators for updating evidence resources To develop and test strategies for updating evidence resources
- 20. Knowledge Distillation Improve usability of systematic reviews (Straus, Hebert, Grimshaw) To develop and test different forms of systematic reviews through iterative usability testing with generalist physicians To determine the feasibility of an internet-based trial of the impact of these formats on the ability of generalist physicians to understand and apply evidence to patients
- 21. Conclusions Relevant Reliable Readable FORECASTR 3