Developing your research question Fiona Alderdice and Mike Clarke

What is a systematic review? Scientific research Seeks to minimise bias Avoids undue emphasis on a single study Maximises the power of previous research

Overwhelming amount of healthcare literature New research is rarely reported in context Reliable knowledge is essential for better health care Better health care is essential for better health Why do we need good literature reviews?

Systematic reviews Include studies that are relevant to the question being asked Minimise bias in findings and conclusions Are becoming more common Are not limited to Cochrane reviews Often required by funders

Key components of reviewing  Stating objectives and eligibility criteria  Identifying (all) potentially eligible studies  Applying eligibility criteria  Assembling most complete dataset feasible  Narrative analysis of the dataset, (meta- analysis also possible)  Discussion and conclusions

What makes a good review?

Criteria for a ‘good’ review Does it address a focused question? Are the inclusion criteria appropriate? Is it unlikely that important, relevant studies were missed? Was the validity of the included studies appraised? Were assessments of studies reproducible? Are the results similar from study to study?

Does the review address a focused question? Remember: reviews are retrospective

Are the inclusion criteria appropriate? Remember: reviews are retrospective

Is it likely that important, relevant studies were missed? Where did they search? When did they search?

Was the validity of included studies appraised? What makes a good study?

Were assessments of studies reproducible? Who did these assessments? When did they do them?

Are the results similar from study to study? Heterogeneity

Other criteria to consider for a ‘good’ review What are the overall results of the review? How precise are the results? Can the results be applied to patient care? Were all the important outcomes considered? Are the benefits worth the harms and costs?

Summary The question for the systematic review needs to be clear Use the domains (PICOS or PEOS) to plan the review The inclusion and exclusion criteria need to be defined, and to be appropriate to the question The search needs to balance the time available with finding as many studies as possible

Summary Decide on which studies are relevant for your review Provide a summary table of results Provide a narrative of your results Look at the quality of the studies in the review Draw conclusions on the quality of evidence and implications for practice

Formulating the question for a review

Does drinking coffee raise people’s blood pressure?

Does drinking coffee raise people’s blood pressure?

Does drinking coffee raise people’s blood pressure?

Does drinking coffee raise people’s blood pressure ?

Participants Interventions Comparsion Group Outcome measures Study designs

Alternative versus standard packages of antenatal care for low-risk pregnancy to improve maternal and neonatal morbidity and mortality

Psychosocial interventions for supporting women to stop smoking in pregnancy

Not all questions are about interventions

Prognosis In infants born prematurely, compared to those born at full term, what is the subsequent lifetime prevalence of sensory deafness?

Diagnosis For pregnant women, is nuchal translucency ultrasound plus serum biochemistry testing in the first trimester as accurate (ie with equal or better sensitivity and specificity) as conventional amniocentesis for Down’s Syndrome

Formulating the question for a review of QUALITATIVE research

PEO format (qualitative) Participants and the problem Exposure Outcome or themes Study design

Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health

Why Do Women Not Use Antenatal Services in Low- and Middle-Income Countries?

Women’s perceptions and experiences of group cognitive behaviour therapy and other group interventions for postnatal depression

Your review question Don’t worry if your question does not exactly fit a PICOS/PEOS format - you may find that some elements apply while others do not. The formats are simply there to help you examine your question in detail, develop search terms and outline an effective search strategy.

The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) The GRADE working group has developed a common, sensible and transparent approach to grading quality of evidence and strength of recommendations for systematic reviews and guidelines Also consider …

‘GRADE is much more than a rating system. It offers a transparent and structured process for developing and presenting evidence summaries for systematic reviews and guidelines in health care and for carrying out the steps involved in developing recommendations. ’ Guyatt et al (2011) GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables J Clin Epid ,

GRADE is “outcome centric”: rating is made for each outcome, and quality is likely to vary from one outcome to another within a single study and across a body of evidence. Quality is rated by: Limitations, Inconsistency, Indirectness, Imprecision, Publication bias

Some addresses The Cochrane Collaboration The Cochrane Library

ESO MASTERCLASS Systematic reviews in cancer care, guidelines and research June 2016 Belfast