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Providing the Consumer Perspective: How to comment on Cochrane reviews and protocols
Tamara Rader
Cochrane Musculoskeletal Group
March 6, 2008
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Welcome!
Introductions Any questions?
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Outline of workshop
Background The production of Cochrane reviews Group work: Corticosteroid injection for
trigger finger in adults. Common concerns of consumers Anything else?
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The importance of your input
consumers have expertise in the experience of the illness
they offer unique suggestions “from a strong knowledge base (often based on their personal experience and that of other health service users)”
consumers bring a new perspective and a fresh set of eyes
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Evidence of the value of consumer input
2006 Cochrane review looked at methods of consumer involvement that found:
Involving consumers to develop patient information improves its clarity and relevance;
telephone calls and face-to-face meetings may engage consumers more and change priority setting than mailed surveys
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Why we like consumer opinions:
Add value to the protocols and reviews Help us save time by identifying priorities Ultimately make the review more meaningful
and relevant Consumer opinions help fulfill one of the
requirements of evidence-based health care
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Evidence-Based Health Care
Evidence/Information Expertise or experience
Values, preferences, needs
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What is “evidence”?
Cohort studies Case control studies Cross sectional surveys Case reports Clinical trials Randomized controlled trials Reviews Systematic reviews
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Problem of information management
Over 20,000 medical journals published per year
Published research of variable quality and relevance
Health care professionals often poorly trained in critical appraisal skills
Average time professionals have available to read = <1 hour/week
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Need to put results into context
The results of individual studies need to be interpreted alongside the totality of evidence (systematic reviews)
Emphasis on individual studies may distract us
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What do we need to manage the flow of information, keep it in context, and not be mislead by individual studies?
Reviews!
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Reviews
Are a collection of material on a given subjectLooks at all studies on a specific topic (treatment,
correct way to diagnose, prevention)Two ways to review literature: Narrative or Systematic
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Narrative Reviews of the Literature
Concerns:- Not focused- Studies excluded or missed- Inappropriate assessment of studies- Inappropriate comparison of studies- Author bias
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What is a systematic review?
Systematic reviews are a way of synthesizing research evidence from many studies
Systematic reviews are a basic building block for planning future research
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NARRATIVE VS SYSTEMATIC
equal weight of studies High quality studies and weighted
General overview Focused question
?Search strategy Methodical and reproducible search
?assessment of studies Quality & relevance assessed
?bias Impartial and relevant results
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Meta-analysis
The use of statistical techniques in a systematic review to integrate the results of included studies.
Cochrane Collaboration (2005) Glossary of Terms in The Cochrane Collaboration
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Writing Reviews
Commenting on Reviews
Editing Reviews
Disseminating Reviews
Searching for good studies
Management
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People in Cochrane
Over 10,000 involved internationally About 80 countries Mostly volunteers Diverse backgrounds, experience and
expertise
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People in Cochrane
Epidemiologists/Statisticians
Healthcare professionals
Consumers
Librarians
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The production of Cochrane reviews
Register the title Write the protocol Write the review Update every 2 years
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Steps in Production
Identify and prioritize topics
to synthesize
TITLE PROTOCOL REVIEW
Plan how to synthesize the studies
Identify why important to do this synthesis
Identify special groups to look at, benefits & harms to report, factors that might change the results
Write the protocol
Send protocol for comment
Edit protocol
Find, analyze and synthesize the studies
Interpret results and determine impact of findings
Write review
Send review for comment
Edit review
Publish Cochrane review
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Preparing a Title
TITLE
• evidence of value in identifying primary research topics, avoid duplication• show the difference in what is done and what would like to see done
Challenges• not an emphasis• reviewer driven• individual bias or public consensus not known
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Preparing a Protocol
PROTOCOLValue in recognizing all factors in studies that are relevant and important to people making health care decisions
•Background, Participants, Interventions, Outcomes
Examples:• peer review of protocols• working with reviewers
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Preparing the review
REVIEW • value of consumers to determine meaning of the results to other consumers and put results in context
Challenges• knowledge of methods, analysis, limitations • time commitment (mutual) and recruitment• feedback and recognition• timelines
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What is found in a Cochrane Review?
Consumer summary (Synopses, Plain Language Summary)
Abstract Background Objectives Selection Criteria for studies Search strategy Methods of the review Description of studies Methodological qualities of included studies Results Summary of analyses Conclusions Potential conflict of interest Acknowledgements
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Common consumer concerns:
“What is the difference between the abstract and synopses?”
The Synopses is aimed at consumers and the Abstract is aimed at practitioners and policy makers
Synopses is in plain language Both follow a structured format
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Consumer concerns continued…
“This writing is unclear and I noticed some mistakes.”
Authors come from around the world, English may not be their first language.
Don’t worry about typos or grammar, reviews get copy-edited.
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Consumer concerns continued…
“This treatment is not available to me.” Cochrane have world-wide coverage of
treatments and some might be more common in other places.
Probably worthwhile to note the reason the treatment is not available: for example, not covered by insurance, too expensive, not part of normal care.
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Consumer concerns continued…
“Do I have to print all of it?”
You don’t have to print the references or characteristics of excluded studies. They probably aren’t necessary for you to give input into the review.
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Consumer concerns continued…
“I don’t understand this condition/intervention/statistic”
We try to give you reviews on topics you have experience or interest in
Review groups can offer help It’s always fine to write that you don’t
understand something, but even better if you can say why.
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Consumer concerns continued…
“Can I have some feedback on my comments?”
Feedback usually comes from the editor We try to send the review to the consumer
who did the protocol As in peer review, authors must address
each comment from the consumer
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Consumer concerns continued…
“I’m not feeling well, and I can’t comment in the near future”
Other ways to become involved A larger pool of consumer reviews means
that no one feels over burdened
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Other tips:
Be specific in your comments Be practical, if you feel a major outcome is
missing, suggest that it be added when the review is updated
Be constructive in your criticism.
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Collaborative, not adversarial.
Editors, authors, and consumers are all working toward the same goal.