In healthcare research, evidence-based decision-making is essential, elevating systematic literature reviews (SLRs) as the go-to method. These reviews meticulously assess and consolidate research on specific topics, setting the standard for evidence-based practice. Yet, with the surge in SLRs, the need for effective methods to navigate and synthesize their outcomes became crucial. This gave rise to overviews of SLRs (also referred to as umbrella reviews, meta-reviews, or cumulative reviews), offering a comprehensive view by amalgamating findings from multiple SLRs.[1]
Umbrella reviews offer a comprehensive understanding of the current state of knowledge on a specific topic by consolidating the findings from multiple SLRs. They help identify gaps, inconsistencies, and emerging trends in the research landscape. However, ensuring the quality and transparency of overviews is crucial for their reliable interpretation and application. Though the PRISMA statement and its various extensions already provide reporting guidelines for various types of SLRs, none of the PRISMA extensions currently cater exclusively to reporting overviews of SLRs. This led to the development of the Preferred Reporting Items for Overviews of Reviews (PRIOR) statement in 2022 to provide a comprehensive framework for reporting overviews of SLRs.[1, 2]
The PRIOR statement includes a checklist with 27 main items organized into seven sections, namely Title, Abstract, Introduction, Methods, Results, Discussion, and Other Information, each prescribing a critical role in ensuring a comprehensive and transparent overview of systematic reviews. The PRIOR statement recommends that the title of the umbrella reviews must clearly identify the report as an overview of reviews, and the abstract must provide a comprehensive and accurate summary of the purpose, methods, and results of the overview. The introduction must contain the rationale behind conducting the overview, with explicitly stated objectives establishing the study’s context and goals.[3,4]
The PRIOR statement emphasizes that the methods section of the umbrella review must meticulously cover eligibility criteria, information sources, selection processes, data collection process, and synthesis methods and provide a list of data items. The methods section must also contain the risk of bias assessment and reporting bias assessment, in addition to a certainty assessment. The results section should present exhaustive details, including systematic review characteristics, primary study overlap, risk of bias assessments, and synthesized findings, and also present the details of certainty of evidence. The discussion should critically interpret findings, highlight any discrepancies, discuss limitations, and explore implications for practice, policy, and future research. The “Other Information” section should address essential aspects such as registration, support, competing interests, author contributions, and the availability of data and materials, contributing to the overall integrity and accessibility of the umbrella review.[4]
The PRIOR statement confers numerous benefits, serving as a crucial tool for robust reporting of umbrella reviews. By providing a standardized checklist, PRIOR ensures improved reporting quality, mitigating the risk of omitting crucial information and fostering consistency across diverse reviews. This not only enhances the overall transparency of research methodologies but also facilitates efficient replication of the review process, contributing to scientific rigor and allowing for timely updates based on emerging evidence. Moreover, PRIOR encourages the use of standardized data extraction forms and tables, streamlining the synthesis process across multiple reviews and resulting in more accurate and reliable conclusions. Ultimately, overviews adhering to PRIOR guidelines become powerful tools for informing evidence-based decision-making in clinical practice, policy formulation, and healthcare resource allocation, amplifying their impact on the healthcare landscape.[5]
In its present iteration, the PRIOR statement helps in the reporting of umbrella reviews of healthcare interventions only and might not be suitable for other types of umbrella reviews (e.g., qualitative, diagnostic accuracy). Development of extensions to the PRIOR statement, similar to PRISMA extensions, might enhance the usability of the PRIOR statement to other types of reviews as well.[5]
As evidence synthesis continues to play a pivotal role in healthcare decision-making, the need for standardized reporting has never been more crucial. PRIOR, with its meticulous development process, tailored approach for umbrella reviews, and emphasis on transparency, contributes significantly to the advancement of evidence-based clinical decision-making. Collaboration among researchers, authors, editors, and publishers is imperative to overcome existing challenges and refine the application of reporting guidelines in the dynamic field of healthcare research.
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References
- Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC medical research methodology. 2011 Dec;11(1):1-6.
- Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021 Apr 1;88:105906.
- Pollock M, Fernandes RM, Pieper D, et al. Preferred Reporting Items for Overviews of Reviews (PRIOR): a protocol for development of a reporting guideline for overviews of reviews of healthcare interventions. Systematic reviews. 2019 Dec;8:1-9.
- Gates M, Gates A, Pieper D, et al. Reporting guideline for overviews of reviews of healthcare interventions: development of the PRIOR statement. BMJ. 2022 Aug 9;378:e070849.
- Yang N, Liu H, Zhang K, et al. Viewpoints on the PRIOR statement-a reporting guideline for overviews of reviews. Ann Transl Med. 2023 Mar 15;11(5):230.