Cochrane Consumers and Communication Group, Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria, 3086, Australia.
Health Res Policy Syst. 2019 Mar 28;17(1):32. doi: 10.1186/s12961-019-0435-0.
Every healthcare encounter involves some form of communication and there is growing recognition that effective health communication is central to the delivery of safe, high-quality healthcare. Conversely, poor communication has a range of adverse consequences for those receiving healthcare and the systems delivering care, including elevated patient safety risks. Increasing understanding and documentation of the key role that good communication plays in healthcare design and delivery has meant there is growing demand from policy-makers and other decision-makers for evidence on the effects of health communication interventions - that is, how best to communicate. While systematic reviews of such interventions are fundamental to building this evidence base, such interventions and reviews are often highly complex and pose considerable challenges for authors and editors. In this paper, we describe our experience as a Cochrane editorial group identifying common issues in reviews of communication interventions and developing resources to support authors to better meet these challenges. Our analysis found that issues typically fell into one or more of the following three stages of the review process: understanding and applying systematic review methods (e.g. selecting outcomes for analysis); reporting the review's methods (e.g. describing key decisions made in conducting the review); and interpreting the findings (e.g. incorporating quality of the evidence into findings of the review). We also found that common issues reflected both practical difficulties (such as the typically large size of reviews and disparate measures for outcomes) and conceptual challenges (for instance, the difficulties of identifying comparisons). While extensive advice for Cochrane systematic reviewers exists, this standardised advice does not cover all of the issues emerging for complex communication reviews. In response, we therefore developed a collection of resources, both general and targeted to specific methodological issues. Here, we describe the types of resources developed and the aims of these, the rationale for why we needed to fill specific gaps in existing advice, and reflect on the lessons for future editorial practice, policies and research in relation to the implementation of Cochrane review methods in the area of health communication.
每次医疗保健接触都涉及某种形式的沟通，人们越来越认识到，有效的健康沟通是提供安全、高质量医疗保健的核心。相反，沟通不畅会对接受医疗保健和提供护理的系统产生一系列不利后果，包括增加患者的安全风险。越来越多的人理解并认识到良好沟通在医疗保健设计和提供中的关键作用，这意味着政策制定者和其他决策者对有关健康沟通干预措施效果的证据（即如何进行最佳沟通）的需求不断增加。虽然对这些干预措施进行系统评价是构建这一证据基础的基础，但此类干预措施和评价通常非常复杂，给作者和编辑带来了相当大的挑战。在本文中，我们描述了作为 Cochrane 编辑团队的经验，即确定沟通干预措施评价中常见问题，并开发资源以支持作者更好地应对这些挑战。我们的分析发现，问题通常属于评价过程的以下三个阶段之一或多个阶段：理解和应用系统评价方法（例如，选择分析的结果）；报告评价方法（例如，描述在进行评价时做出的关键决策）；和解释结果（例如，将证据质量纳入评价结果）。我们还发现，常见问题既反映了实际困难（例如，评价通常规模较大且结果的衡量指标各不相同），也反映了概念上的挑战（例如，确定比较的困难）。虽然有广泛的 Cochrane 系统评价作者建议，但这些标准化建议并未涵盖复杂沟通评价中出现的所有问题。因此，我们开发了一系列资源，包括一般性资源和针对特定方法学问题的资源。在这里，我们描述了开发的资源类型以及这些资源的目的、我们需要填补现有建议中特定空白的理由，以及反思在实施 Cochrane 评价方法方面未来编辑实践、政策和研究的相关经验教训，这些方法应用于健康沟通领域。
