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将定性证据综合纳入健康指南制定的方法学文献的系统评价。

Systematic review of the methodological literature for integrating qualitative evidence syntheses into health guideline development.

作者信息

Carmona Chris, Baxter Susan, Carroll Christopher

机构信息

School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.

出版信息

Res Synth Methods. 2021 Jul;12(4):491-505. doi: 10.1002/jrsm.1483. Epub 2021 Feb 25.

Abstract

Guidelines produced by local, national and international bodies underpin clinical practice and healthcare services worldwide. For guidelines to be based on the best available evidence, it is critical that syntheses of both qualitative and quantitative evidence are used to inform decision-making. As methods for qualitative evidence syntheses (QES) develop, they are increasingly able to inform health guideline production. However, the process whereby this form of evidence is considered and incorporated tends to be unclear. This systematic review synthesized existing guidance concerning the use of QES in guideline development. Sources published in English that described or prescribed methods for incorporating QES into evidence-based health guidelines were eligible for inclusion. Seventeen relevant papers were identified. The literature indicates that there is a reasonable consensus about many stages of conducting a QES to inform guideline development. Areas needing further exploration include: the way that committees engage with QES; the usefulness of different QES methodologies; and understanding of how expert committees use evidence. Methods for producing QES for guideline committees tend to be similar to quantitative systematic review methods in terms of searching, quality appraisal, systematic management of data, and presentation of results. While this allows transparency and accountability, it could be argued that it is less "true" to the principles of being led by the data, which are fundamental to most qualitative research. Understanding the process of using QES to produce guidelines is critical to determining their validity and applicability, and to ensure that healthcare provision is based on the best available evidence.

摘要

由地方、国家和国际机构制定的指南是全球临床实践和医疗服务的基础。为了使指南基于最佳可得证据,至关重要的是使用定性和定量证据的综合来为决策提供信息。随着定性证据综合(QES)方法的发展,它们越来越能够为健康指南的制定提供信息。然而,这种形式的证据被考虑和纳入的过程往往不明确。本系统综述综合了关于在指南制定中使用QES的现有指南。以英文发表的描述或将QES纳入循证健康指南的方法的文献有资格被纳入。共识别出17篇相关论文。文献表明,在进行QES以为指南制定提供信息的许多阶段存在合理的共识。需要进一步探索的领域包括:委员会参与QES的方式;不同QES方法的有用性;以及对专家委员会如何使用证据的理解。为指南委员会制作QES的方法在搜索、质量评估、数据系统管理和结果呈现方面往往与定量系统综述方法相似。虽然这允许透明度和问责制,但可以认为这与以数据为导向的原则不太“相符”,而数据导向是大多数定性研究的基本要素。理解使用QES来制定指南的过程对于确定其有效性和适用性以及确保医疗服务基于最佳可得证据至关重要。

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