Choosing the Important Outcomes for a Systematic Review of a Medical Test

In this chapter of the Evidence-based Practice Centers , we describe how the decision to use a medical test generates a broad range of outcomes, and suggest how each of these outcomes might be considered for inclusion in a systematic review. Awareness of these varied outcomes affects how a decisionmaker balances the benefits and risks of the test; therefore, a systematic review should present the evidence on their diversity. The key outcome categories include clinical management outcomes; direct health effects; emotional, social, cognitive, and behavioral responses to testing; legal and ethical outcomes; and costs. We describe the challenges of incorporating these outcomes in a systematic review, suggest a framework for generating potential outcomes for inclusion, and describe the role of stakeholders in choosing the outcomes for study. Finally, we give examples of systematic reviews that either included a range of outcomes or that might have done so. This chapter puts forward a set of key messages for systematic reviewers: Consider both the outcomes that are relevant to the process of testing and those relevant to the results of the test. Consider inclusion of outcomes in all five domains: clinical management effects; direct test effects; emotional, social, cognitive, and behavioral effects; legal and ethical effects; and costs. Consider to which group the outcomes of testing are most relevant. Given resource limitations, prioritize which outcomes to include. This decision depends on the needs of the stakeholder(s), who should be assisted in prioritizing the outcomes for inclusion.