Prioritizing Evidence Syntheses Sharon E. Straus MD MSc FRCPC Canada Research Chair Knowledge Translation and Quality of C...
Declaration of Competing Interests <ul><li>Associate Editor for ACP JC, EBM Journal </li></ul><ul><li>Senior Editor, CMAJ ...
 
 
Principles of the Program <ul><li>F easibility </li></ul><ul><li>O bjectivity </li></ul><ul><li>R esponsiveness </li></ul>...
The ‘3 Rs’ of Evidence Synthesis <ul><li>Relevant </li></ul><ul><li>Reliable </li></ul><ul><li>Readable </li></ul>
The ‘3 Rs’:  Relevant <ul><li>Reviews should be relevant to the needs of the end users </li></ul><ul><ul><li>Different typ...
Relevant:  Types of reviews <ul><li>Most traditional systematic reviews of interventions don’t consider context </li></ul>...
Types of reviews <ul><li>What about questions like: </li></ul><ul><ul><li>Why do school meals programs work in one setting...
Types of reviews <ul><li>Realist reviews </li></ul><ul><ul><li>How do complex programs/interventions work in certain conte...
Relevant:  Rapid reviews <ul><li>Decision makers often have need for timely reviews </li></ul><ul><li>Producers of evidenc...
The ‘3 Rs’:  Reliable <ul><li>Producers of evidence syntheses must ensure that the evidence is valid and the methods for i...
The ‘3 Rs’:  Readable <ul><li>Systematic reviews aren’t being used consistently in decision making by: </li></ul><ul><ul><...
Readable <ul><li>Lack of detail about the intervention, its accessibility and risk of adverse events in many systematic re...
Readable <ul><li>Reviews need to be presented in user friendly formats that facilitate uptake at policy meetings and in cl...
Knowledge Translation Canada <ul><li>Its aims are to develop a transformative research program to improve the health of Ca...
KT Canada <ul><li>Will focus on targeting 3 stakeholder groups and 4  interlinked research programs:   </li></ul><ul><ul><...
Knowledge Distillation <ul><li>Improve uptake of reporting guidelines such as CONSORT (Moher, Grimshaw, Straus) </li></ul>...
Knowledge Distillation <ul><li>Efficient updating of evidence-based resources (Haynes, Moher) </li></ul><ul><ul><li>To ide...
Knowledge Distillation <ul><li>Improve usability of systematic reviews (Straus, Hebert, Grimshaw) </li></ul><ul><ul><li>To...
Conclusions <ul><li>Relevant </li></ul><ul><li>Reliable </li></ul><ul><li>Readable </li></ul><ul><li>FORECASTR 3 </li></ul>
 
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Discussant: Prioritizing Evidence Syntheses

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  • Discussant: Prioritizing Evidence Syntheses

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

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