Evaluation of patient involvement in a systematic review and meta-analysis of individual patient data in cervical cancer treatment (original) (raw)
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Health Expectations, 2023
Introduction Despite the growing evidence on patient and public involvement (PPI) in health research, little emphasis has been placed on understanding its quality and appropriateness to evidence synthesis (ES) and systematic reviews (SR). This study aimed to synthesise qualitative evidence on the benefits, challenges, and best practices for PPI in ES/SR projects from the perspectives of patients/public and researchers. Methods We searched Ovid MEDLINE, Ovid EMBASE, Cochrane Library and CINAHL Plus. We also searched relevant grey literature and conducted hand-searching to identify qualitative studies which report the benefits and challenges of PPI in individual ES/SR projects. Studies were independently screened by two reviewers for inclusion and appraised using the Joanna Briggs Institute's Qualitative Tool. Included studies were synthesised narratively using thematic synthesis. Results The literature search retrieved 9923 articles, of which eight studies were included in this review. Five themes on benefits emerged: two from patients'/public's perspective—gaining knowledge, and empowerment; and three from researchers' perspective—enhancing relevance, improving quality, and enhancing dissemination of findings. Six themes on challenges were identified: three from patients'/public's perspective—poor communication, time and low self-esteem; and three from researchers' perspective—balancing inputs and managing relations, time, and resources and training. Concerning recommendations for best practice, four themes emerged: provision of sufficient time and resources, developing a clear recruitment plan, provision of sufficient training and support, and the need to foster positive working relationships. Conclusion Highlighting the benefits and challenges of PPI in ES/SR projects from different stakeholder perspectives is essential to understand the process and contextual factors and facilitate meaningful PPI in ES/SR projects. Future research should focus on the utilisation of existing frameworks (e.g., Authors and Consumers Together Impacting on eVidencE [ACTIVE] framework) by researchers to help describe and/or report the best approaches and methods for involving patients/public in ES/SRs projects. Patient and Public Contribution This review received great contributions from a recognised PPI partner, the Chair of the Cochrane Consumer Network Executive, to inform the final stage of the review (i.e., interpretation, publication and dissemination of findings). The PPI partner has been included as an author of this review.
JAMA, 2014
Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner. For reviews that are sufficiently credible, clinicians must decide on the degree of confidence in the estimates that the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the body of evidence; the precision and consistency of the results; whether the results directly apply to the patient of interest; and the likelihood of reporting bias. Sh...
Systematic Reviews in Health Care: A Practical Guide
Epidemiology, 2002
. Glasziou and coauthors have written a book that covers the in and outs of conducting a systematic review. The exponentially growing knowledge base in medicine, increasing numbers of outlets for new knowledge, and (some would argue) less time for clinicians and researchers to read and reflect, mean that we have grown more dependent on systematic reviews to keep up. In a perfect world the Cochrane Collaboration would do all of the reviews for us using their robust systems and methods, but they can't, so there is a need to learn how to do it ourselves. The most important contribution of the Glaziou et al. book is that is provides a practical guide for us to do so. The book comes in two major parts: General Methods and Question Specific Methods. It is also worth noting that the appendixes are extremely informative and the glossary comes in handy for the nonepidemiologist reader. The General Methods section is especially useful-the five chapters are a quick review for the experienced user and a good general overview for the novice. Chapter 1, "The Question," provides an excellent summary of various study designs that are optimal for answering different types of research questions (e.g., interventions, diagnostic tests) and a clear example of how to state such questions. The point is nicely made that the question driving the review needs to be well-stated and appropriately focused before a search is undertaken. Chapter 2, "Finding Relevant Studies," is probably the best in the book, given a minimal level of experience with Medline and MeSH terms. This is a good chapter for everyone who uses Medline and similar search tools, whether or not they are actually doing a systematic review. Chapter 3, "Appraising and Selecting Studies," focuses on the quality of the research. Clearly not all studies are created equal and the user or reviewer needs to decide what is critical for a particular review. The points were clear and reachable, although I found myself wanting the presentation to be a bit more concrete. What does an actual abstraction form look like? It was hard to wait patiently for the checklists that were coming in part 2. The going started to get tougher in chapter 4, "Summarizing and Synthesizing the Studies." The sections on fixed and random effects models and measures of heterogeneity were especially difficult to follow. The chapter does a good job of acquainting the reader with the important issues, but for a user's guide, the level of detail was probably insufficient to lead one through the process. The very brief chapter 5, "Applicability: Returning to the Question," was again clear and easy to follow. Part 2, "Question Specific Methods," was composed of five chapters, each devoted to the five types of questions that one might pursue in a review: interventions, frequency and rate, diagnostic tests, etiology and risk factors, and prediction-prognosis and risks. All chapters followed the same outline, drawing on the titles of chapters 1 through 4, with some having additional sections. The organization was appealing and helpful. These chapters were uniformly strong, especially the first four. Overall, this part of the book complements the first part and adds much needed detail to the more generic concepts presented earlier. So, how good is the book? My complaints are few and relatively minor. First, there is a certain unevenness in what is presented. I was unsure of the target audience because a considerable amount of information was presented, but probably not enough to enable a novice to do a complete systematic review. Second, some of the important points regarding how much time and effort it takes to do a review were in the introduction and might be missed. For example, data from the same series of patients might show up in multiple manuscripts and this will not automatically be discovered. Further, the authors make the process seem so straightforward that it is easy to overlook the fact that it takes months to do a good review, and after reading hundreds of articles only a handful may be worthy of including in the review. Third, there was really nothing presented on "abstracting" the relevant data as opposed to assessing the quality of the study. A very important part of the process is to design and pilot an abstraction sheet that captures relevant data. At only 116 pages, including many graphs, tables, and figures, the book can easily be read in a couple of hours. A very attractive feature used throughout is the side box dedicated to summaries and hints, presented in the margins every few pages. I look forward to a second edition with some upgrades and expansions. These authors are clearly such experts they need to do more to aggregate and share their collective practical experience, perhaps using helpful hints bulleted at the end of each chapter. Tables with examples of reviews for each question type, and suggested readings about meta-analyses and reviews, would be nice additions. Finally (and selfishly), for it to be a maximally useful practical guide, I would like to see one example (real or fictional) taken from beginning to end. This could be interspersed in the relevant chapters, or presented as an appendix. My minor concerns aside, this stands as a strong competitor in the growing list of available resources that lead the reader through the systematic review process. A few additions would turn it from an excellent resource into a "must have" manual.
In pursuit of certainty: can the systematic review process deliver?
BMC Medical Informatics and Decision Making, 2013
Background: There has been increasing emphasis on evidence-based approaches to improve patient outcomes through rigorous, standardised and well-validated approaches. Clinical guidelines drive this process and are largely developed based on the findings of systematic reviews (SRs). This paper presents a discussion of the SR process in providing decisive information to shape and guide clinical practice, using a purpose-built review database: the Cochrane reviews; and focussing on a highly prevalent medical condition: hypertension.
Systematic reviews: let's keep them trustworthy
British Journal of Dermatology, 2017
The advent of systematic reviews is relatively new and represents an important tool to summarize the best evidence for studying the effects of healthcare interventions. Without systematic reviews, the effectiveness of therapies (or lack of benefit) can remain unrecognized for many years. The Cochrane logo (www.cochranelibrary.com) provides a good example: it shows the forest plot of a systematic review describing how corticosteroids given to women who are about to give birth prematurely can save the life of the newborn child, an important summary of the evidence available at the time. Systematic reviews as a publication type have increased over the last decade. They were initially concerned with therapeutic interventions, but there are now many more types, from ‘umbrella’ reviews (reviews of reviews) to reviews of observational studies and case reports. The methods of the review will depend on the question being asked. Systematic reviews carry an aura of infallibility but are highly...
Research Involvement and Engagement
Researchers are expected to actively involve stakeholders (including patients, the public, health professionals, and others) in their research. Although researchers increasingly recognise that this is good practice, there is limited practical guidance about how to involve stakeholders. Systematic reviews are a research method in which international literature is brought together, using carefully designed and rigorous methods to answer a specified question about healthcare. We want to investigate how researchers have involved stakeholders in systematic reviews, and how involvement has potentially affected the quality and impact of reviews. We plan to bring this information together by searching and reviewing the literature for reports of stakeholder involvement in systematic reviews. This paper describes in detail the methods that we plan to use to do this. After carrying out comprehensive searches for literature, we will: 1. Provide an overview of identified reports, describing key information such as types of stakeholders involved, and how. 2. Pick out reports of involvement which include detailed descriptions of how researchers involved people in a systematic review and summarise the methods they used. We will consider who was involved, how people were recruited, and how the involvement was organised and managed. 3. Bring together any reports which have explored the effect, or impact, of involving stakeholders in a systematic review. We will assess the quality of these reports, and summarise their findings. Once completed, our review will be used to produce training resources aimed at helping researchers to improve ways of involving stakeholders in systematic reviews.
Methodology in conducting a systematic review of systematic reviews of healthcare interventions
BMC Medical Research …, 2011
Background: Hundreds of studies of maternity care interventions have been published, too many for most people involved in providing maternity care to identify and consider when making decisions. It became apparent that systematic reviews of individual studies were required to appraise, summarise and bring together existing studies in a single place. However, decision makers are increasingly faced by a plethora of such reviews and these are likely to be of variable quality and scope, with more than one review of important topics. Systematic reviews (or overviews) of reviews are a logical and appropriate next step, allowing the findings of separate reviews to be compared and contrasted, providing clinical decision makers with the evidence they need. Methods: The methods used to identify and appraise published and unpublished reviews systematically, drawing on our experiences and good practice in the conduct and reporting of systematic reviews are described. The process of identifying and appraising all published reviews allows researchers to describe the quality of this evidence base, summarise and compare the review's conclusions and discuss the strength of these conclusions. Results: Methodological challenges and possible solutions are described within the context of (i) sources, (ii) study selection, (iii) quality assessment (i.e. the extent of searching undertaken for the reviews, description of study selection and inclusion criteria, comparability of included studies, assessment of publication bias and assessment of heterogeneity), (iv) presentation of results, and (v) implications for practice and research.
The promise and pitfalls of systematic reviews
Annu. Rev. Public Health, 2006
■ Abstract The systematic review "movement" that has transformed medical journal reports of clinical trials and reviews of clinical trials has taken hold in public health, with the most recent milestone, the publication of the first edition of The Guide to Community Health Services in 2005. In this paper we define and distinguish current terms, point out important resources for systematic reviews, describe the impact of systematic review on the quality of primary studies and summaries of the evidence, and provide perspectives on the promise of systematic reviews for shaping the agenda for public health research. Several pitfalls are discussed, including a false sense of rigor implied by the terms "systematic review" and "meta-analysis" and substantial variation in the validity of claims that a particular intervention is "evidence based," and the difficulty of translating conclusions from systematic reviews into public health advocacy and practice.
Appraising systematic reviews: a comprehensive guide to ensuring validity and reliability
Systematic reviews play a crucial role in evidence-based practices as they consolidate research findings to inform decision-making. However, it is essential to assess the quality of systematic reviews to prevent biased or inaccurate conclusions. This paper underscores the importance of adhering to recognized guidelines, such as the PRISMA statement and Cochrane Handbook. These recommendations advocate for systematic approaches and emphasize the documentation of critical components, including the search strategy and study selection. A thorough evaluation of methodologies, research quality, and overall evidence strength is essential during the appraisal process. Identifying potential sources of bias and review limitations, such as selective reporting or trial heterogeneity, is facilitated by tools like the Cochrane Risk of Bias and the AMSTAR 2 checklist. The assessment of included studies emphasizes formulating clear research questions and employing appropriate search strategies to construct robust reviews. Relevance and bias reduction are ensured through meticulous selection of inclusion and exclusion criteria. Accurate data synthesis, including appropriate data extraction and analysis, is necessary for drawing reliable conclusions. Meta-analysis, a statistical method for aggregating trial findings, improves the precision of treatment impact estimates. Systematic reviews should consider crucial factors such as addressing biases, disclosing conflicts of interest, and acknowledging review and methodological limitations. This paper aims to enhance the reliability of systematic reviews, ultimately improving decision-making in healthcare, public policy, and other domains. It provides academics, practitioners, and policymakers with a comprehensive understanding of the evaluation process, empowering them to make well-informed decisions based on robust data.