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Evaluating the priority setting processes used across the Cochrane Collaboration

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A workshop in Cochrane Colloquium, Freiburg, Germany Oct 2008 on Ensuring relevance and building enthusiasm for Cochrane reviews: …

A workshop in Cochrane Colloquium, Freiburg, Germany Oct 2008 on Ensuring relevance and building enthusiasm for Cochrane reviews:
determining appropriate methods for identifying priority topics for future Cochrane reviews

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  • 1. Workshop title: Ensuring relevance and building enthusiasm for Cochrane reviews: determining appropriate methods for identifying priority topics for future Cochrane reviews Evaluating the priority setting processes used across the Cochrane Collaboration: Accountability, Reasonability and Equity Cochrane Colloquium, 3-7 October 2008 Freiburg, Germany
  • 2. There is no simple way to set priorities. However, failure to establish a process for priority setting has led to a situation in which only about 10% of health research funds from public and private sources are devoted to 90% of the world’s health problems (measured in DALYs). This extreme imbalance in research funding has a heavy economic and social cost. To make matters worse, even the 10% of funds allocated to the 90% of the world’s health problems are not used as effectively as possible, as health problems are often not prioritized using a defined methodology. Global Forum for Health Research
  • 3. Prioritizing Cochrane Review Topics Relevant to Low- and Middle- Income Countries Peter Tugwell, Vivian Welch, Erin Ueffing, Zulma Ortiz, Mona Nasser, Elizabeth Waters, Jodie Doyle, Andy Oxman 1) Identify what priority-setting approaches are underway by Cochrane entities already and whether/how these can inform priorities for systematic reviews of relevance to LMIC 2) Explore different methods of identifying priorities for systematic reviews for specific audiences, recognizing that priorities may be different (eg for policy- makers, for practitioners). We might convene small working groups of practitioners to identify priorities for systematic reviews at a national or regional level 3) Map existing systematic reviews to identified priorities to identify gaps/needs for new systematic reviews, as well as showing whether the Cochrane Database of Systematic Reviews already answers high-priority questions relevant to LMIC
  • 4. Background: • Ebrahim S, Moore T. Priority setting for review topics in the Cochrane Review Groups. 7th Cochrane Colloquium, 5-9 October 1999, Rome, Italy • Ghersi D, Kennedy G, Rio P, Shea B. Consumer Setting Priorities for Cochrane Review Groups. 5-9 October 1888, Rome, Italy • Vet HCW, Korese MEAL, Scholten RJPM. The efficacy Of treatments for chronic benign pain disorders: setting research priorities by literature searches With minimal reading. 8th Cochrane Colloquium 25-29 October 2000, Cape town, South Africa. • Survey of prioritisation, commissioning and cochranisation of non-Cochrane reviews, Adrian M Grant, CCSG, Khon Kaen, April 2006 • Bellorini J, Doree C. A method for priortising review topics: map of distribution of randomized controlled trials (RCTs) in the Cochrane Review Group Trials Register. 14th Cochrane Colloqiuium 23-26 October 2006, Dublin, Ireland. • Doyle J, McDonald L, Bailie R, Waters E, Armstrong R. Prioritising and promoting topics for systematic reviews to address the public health needs of indigenous people. 14th Cochrane Colloqiuium 23-26 October 2006, Dublin, Ireland. • Nasser M, Lodge M, Fedorowicz Z. The relevance of Cochrane Reviews to the Cancer Priorities in Iran. 15th Cochrane Colloquium 23-27 October 2007, Sao Paulo, Brazil.
  • 5. • We have contacted 67 Cochrane review groups and Cochrane fields. • 52 groups responded (about 78%) • 17 did not have a priority setting exercise (about 25%) • 8 had some relevant editorial process for accepting titles (about12%) • 27 had a prioritsation process or planned one (about 40%)
  • 6. Summary of ways the CRGs make decisions on prioritising new or updated reviews: 1. Adapting priorities from other external organizations. 2. Using the database of uncertainties (DUETS) 3. Asking for recommendations and suggestions from editors (email, survey, face-to-face meetings), authors or other members of the Cochrane Entities (CEs) (survey, email, web based suggestion box). This might be accompanied by a further step on ranking the titles in an editorial board discussion or emailing members of the CEs. 4. Identifying gaps in the existing literature (topics on which a number of trials have been undertaken but no Cochrane review or systematic review exists) in areas which are relevant (as judged by editors, members of the CEs, other stakeholders or identified in guidelines). 5.Using a consensus process involving different stakeholders in the form of a workshop, Delphi process, survey or focus group 6.Using health indicators e.g. Mortality or incidence to prioritise reviews.
  • 7. Criteria for priority setting used by CEs Clinical relevancy and importance Knowledge of new trials available or numbers of them available Improving patient outcomes Importance to NHS priorities (UK based CRG) Achievability and resources required Impact on efficacy and efficiency Timeliness Relevancy to the country (Australian based CRG) Focus of the CRG Interset and priority as defined by individual members How might this Cochrane review contribute to achieving the United Nationa‘s Millenium Development Goals in infectious diseases, maternal motrality or child health? (Infectious diseases CRG) Burden of Disease, magnitude of problem and urgency Importance to developing countries Large scale impact on population. Opportunity for action
  • 8. Challenges: 1. Volunteer based contribution of the author’s 2. The priority setting could be useless if authors would not be interested to take over any of the topics (Some fields provide bursary schemes in the specific topic) 3. Inexperienced authors can not necessarily undertake a prioritize topics which may encounter methodological difficulties 4. Lack of funding and time
  • 9. How to evaluate or compare the processes? Some examples: • “Accountability for Reasonableness” (A4R)(1, 3) • Comparison of various priority setting approaches in the Combined Approach of Matrix (2) • Programme budgeting and marginal analysis (PBMA) (3) References: 1. Martin D, Singer P. A Strategy to improve priority setting in health care institutions. Health care analysis 2003, 11 (1): 59-68. 2. Ghaffar A, Francisco A, Matlin S. The Combined Approach Matrix: A priority setting for health research. June 2004. 3. Gibson J, Mitton C, Martin D, Donaldsen C, Singer P. Ethics and economics: does programme budgeting and marginal analysis contribute to fair priority setting? Journal of Health Services Research & policy 2006: 11(1) : 32-37.
  • 10. “Accountability for Reasonableness” (A4R) A4R is an ethical approach to priority setting that seeks to ensure fairness in how priority-setting decisions are made. Relevance: Decisions should be made on the basis of reasons (i.e. evidence, principles, values, arguments) that ‘fair-minded’ stakeholders can agree are relevant under the circumstances. Publicity: Decisions and their rationales should be made available to stakeholders. Revision and appeals: There should be opportunities to revisit and revise decisions in light of further evidence or arguments, and there should be a mechanism for challenge and dispute resolution. Enforcement: There is a voluntary or regulatory mechanism for ensuring that the other three conditions are met
  • 11. A possible framework to compare the strategies: • Objective of priority Setting and process • Inclusiveness • Equity • Evaluation of the existing evidence coverage • Criteria for priority setting • Continuity (expect of the normal procedure of a CRG) and implementation • Relevance (A4R criteria) • Publicity (A4R criteria) • Appeals (A4R criteria) • Enforcement(A4R criteria) 14 of the processes used by Cochrane entities could be categorized in this table.
  • 12. Discussion Questions: How to select and rank-order criteria for prioritisation? Who should be consulted, and how, in setting and applying criteria? Evidence mapping-how to judge applicability, extrapolation, plausibility of existing, available systematic reviews? How the prioritisation strategies could be integrated into the current roles of all entities within the Collaboration; How to align priority setting with new strategic funding opportunities
  • 13. mona.nasser@iqwig.de