Institute for Evidence in Medicine, Faculty of Medicine, Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany, Breisacher Str. 86, 79110.
Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
BMC Med Res Methodol. 2023 Dec 20;23(1):302. doi: 10.1186/s12874-023-02124-y.
Implications for research (IfR) sections are an important part of systematic reviews (SRs) to inform health care researchers and policy makers. PRISMA 2020 recommends reporting IfR, while Cochrane Reviews require a separate chapter on IfR. However, it is unclear to what extent SRs discuss IfR. We aimed i) to assess whether SRs include an IfR statement and ii) to evaluate which elements informed IfR statements.
We conducted a meta-research study based on SRs of interventions in advanced cancer patients from a previous project (CRD42019134904). As suggested in the Cochrane Handbook, we assessed if the following predefined variables were referred to in IfR statements: patient, intervention, control, outcome (PICO) and study design; concepts underlying Grading of Recommendations, Assessment, Development and Evaluation (GRADE) domains: risk of bias, inconsistency, indirectness, imprecision, publication bias. Data were independently extracted by three reviewers after piloting the data extraction form. Discrepancies were resolved in weekly in-depth discussions.
We included 261 SRs. The majority evaluated a pharmacological intervention (n = 244, 93.5%); twenty-nine were Cochrane Reviews (11.1%). Four out of five SRs included an IfR statement (n = 210, 80.5%). IfR statements commonly addressed 'intervention' (n = 121, 57.6%), 'patient ' (n = 113, 53.8%), and 'study design' (n = 107, 51.0%). The most frequent PICO and study design combinations were 'patient and intervention ' (n = 71, 33.8%) and 'patient, intervention and study design ' (n = 34, 16.2%). Concepts underlying GRADE domains were rarely used for informing IfR recommendations: 'risk of bias ' (n = 2, 1.0%), and 'imprecision ' (n = 1, 0.5%), 'inconsistency ' (n = 1, 0.5%). Additional elements informing IfR were considerations on cost effectiveness (n = 9, 4.3%), reporting standards (n = 4, 1.9%), and individual patient data meta-analysis (n = 4, 1.9%).
Although about 80% of SRs included an IfR statement, the reporting of PICO elements varied across SRs. Concepts underlying GRADE domains were rarely used to derive IfR. Further work needs to assess the generalizability beyond SRs in advanced cancer patients. We suggest that more specific guidance on which and how IfR elements to report in SRs of interventions needs to be developed. Utilizing PICO elements and concepts underlying GRADE according to the Cochrane Handbook to state IfR seems to be a reasonable approach in the interim.
CRD42019134904.
系统评价（SR）中的影响研究（IfR）部分对于告知医疗保健研究人员和决策者非常重要。PRISMA 2020 建议报告 IfR，而 Cochrane 综述则需要单独的章节来讨论 IfR。然而，目前尚不清楚 SR 对 IfR 的讨论程度。我们的目的是：i）评估 SR 是否包含 IfR 陈述；ii）评估哪些元素可以为 IfR 陈述提供信息。
我们基于之前一个项目（CRD42019134904）中对晚期癌症患者干预措施的 SR 进行了元研究。根据 Cochrane 手册的建议，我们评估了以下预定义变量是否在 IfR 陈述中提到：患者、干预、对照、结局（PICO）和研究设计；GRADE 领域的概念：偏倚风险、不一致性、间接性、不精确性、发表偏倚。数据由三位审查员在试用数据提取表后独立提取。每周进行深入讨论以解决分歧。
我们纳入了 261 篇 SR。其中大多数评估了药物干预（n=244，93.5%）；29 篇为 Cochrane 综述（11.1%）。五分之四的 SR 包含 IfR 陈述（n=210，80.5%）。IfR 陈述通常涉及“干预”（n=121，57.6%）、“患者”（n=113，53.8%）和“研究设计”（n=107，51.0%）。最常见的 PICO 和研究设计组合是“患者和干预”（n=71，33.8%）和“患者、干预和研究设计”（n=34，16.2%）。用于为 IfR 建议提供信息的 GRADE 领域的概念很少使用：“偏倚风险”（n=2，1.0%）和“不精确性”（n=1，0.5%），“不一致性”（n=1，0.5%）。为 IfR 提供信息的其他元素包括成本效益考虑（n=9，4.3%）、报告标准（n=4，1.9%）和个体患者数据荟萃分析（n=4，1.9%）。
尽管约 80%的 SR 包含 IfR 陈述，但 SR 中 PICO 元素的报告存在差异。GRADE 领域的概念很少用于得出 IfR。需要进一步研究以评估除晚期癌症患者的 SR 之外的更广泛的可推广性。我们建议需要制定更具体的指南，说明在干预措施的 SR 中应报告哪些和如何报告 IfR 元素。根据 Cochrane 手册利用 PICO 元素和 GRADE 领域的概念来陈述 IfR 似乎是一种合理的方法。
CRD42019134904。
