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.

Thank you!

Tamara Rader613-562-5800

Ext. 2397

trader@uottawa.ca