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  • The Importance of Rapid Review Methods in Healthcare Decision-making

    The Importance of Rapid Review Methods in Healthcare Decision-making

    Systematic literature reviews (SLRs) have always been amongst preferred tools for policy and decision makers owing to their quality of evidence as well as the ability to provide knowledge-base in terms of clinical practice guidelines as well as policy briefs. However, strict methodology followed during the conduct of an SLR can impact its duration, which may range anywhere from 0.5 to 2 years. (1) Along with the stringent guidelines, SLRs not only require two independent reviewers to execute all the necessary procedures of literature review, screening, data extraction and risk of bias appraisal; but also several technical experts, such as librarians, statisticians, subject matter experts, research coordinators and so on. (2)

    Healthcare decision makers frequently require well-timed access to information in order to make informed decision regarding treatment and care. Even though SLRs are a preferred choice, they require a great deal of resources. In addition, the longer duration as required by SLRs may not harmonize with the needs of the researchers requiring a quicker review. For instance, the mean number of hours to conduct SLRs have been estimated to be 1,139 hours (range 216–2,518 hours) with a budget of about $100,000. (3)

    ‘Rapid reviews’ then come into the picture, which simplify or omit the stages involved in conducting SLRs to give quick information. Agency for Healthcare Research and Quality (AHRQ, US) defines a rapid review as “a form of evidence synthesis that may provide more timely information for decision making compared with standard systematic reviews”. (4,5) Today, rapid reviews are increasingly being used to synthesize evidence, particularly for making informed yet promising decisions in healthcare.(1)

    Even though rapid reviews are emerging as a preferred tool for making urgent decisions, there is a dearth of evidence surrounding their methodology.(1,2) A recent scoping review of rapid review methods has reported their conduct to be complicated. Findings of this review show that many important steps in an SLR are often omitted during rapid reviews, such as protocol application, limited literature search, limited inclusion criteria, and lack of quality appraisal among others. Rapid reviews also involve limited interpretation of findings and may cause bias. Many articles in the literature poorly report the methodologies of rapid review, thus warranting further improvement.(2) Therefore, clear gaps exist in transparency in and knowledge about the reliability of rapid reviews.(1) However, there are some areas where rapid reviews can be helpful, such as broader PICO questions, novel or emerging research topics, updates on previous reviews, critical topics, further exploration of a policy or practice using some systematic review methods, and so on.(5)

    The increasing preference for rapid reviews and their application into urgent decision-making emphasizes the need to further explore their characteristics and uses. While researcher opting for rapid reviews are answerable about the time-sensitive needs of the health decision makers they work for, they must do it in line with the expected methodological rigor. For this purpose, methodological research and standard development is crucial. (6)

    In conclusion, not only the methodologies, but also their consequences should be further investigated in order to better implement rapid review methods for making timely decisions. A prospective study, which can compare the results of rapid reviews to those achieved from an SLR around the same topic, can be conducted (1) and will be interesting to look at.

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    References

    1. Khangura S, Konnyu K, Cushman R, et al. Evidence summaries: the evolution of a rapid review approach. Syst Rev 2012; 1:10.
    2. Tricco A, Antony J, Zarin W, et al. A scoping review of rapid review methods. BMC Medicine 2015; 13:224.
    3. Petticrew M, Roberts H. Systematic reviews in the social sciences: a practical guide. Malden, MA: Blackwell Publishing Co.; 2006.
    4. Agency for Healthcare Research and Quality (AHRQ).
    5. Systematic Reviews & Other Review Types. Temple University.
    6. Cochrane Rapid Reviews Methods Group (RRMG).

    Written By: Ms. Tanvi Laghate

    MarksMan Healthcare

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  • How Rapid Reviews Are Assisting in Healthcare Decision Making?

    How Rapid Reviews Are Assisting in Healthcare Decision Making?

    Traditionally, systematic reviews are considered as the gold standard to inform clinical practice and policy decisions. However, systematic reviews are resource and time intensive. The time factor has been identified as a barrier to implementing results from evidence synthesis, as a result of an incongruence between the time required to produce a full systematic review and the time within which policy and other decision makers must take decisions.1,2 Hence, there is an increasing demand and a rising interest from healthcare decision makers and knowledge users for a summary of high-quality evidence within a short time period to support their practice and policy decision-making.1,3

    Rapid reviews are viewed as valid forms of evidence synthesis products that provide sufficient information and advice to base clinical and policy decisions.3 A rapid review enables the provision of a concise summary of the evidence to answer specific policy or research-related questions. This recent interest in RRs could be due to the relatively large resource, time, and budget demands of well conducted systematic reviews.

    The term ‘rapid review’ (RR) has broad and varied definitions, and it is important to know how it differs from a systematic review. Broadly, a rapid review is a type of evidence synthesis product, which includes components of a systematic review, albeit in a simplified form that enables it’s completion in a timely fashion.3,4

    A rapid review differs from a systematic review in terms of the scope of the review question, comprehensiveness of the search, rigour and/or quality control, and the type of synthesis.3,4,5 Overall, a RR is similar to a systematic review in terms of how the evidence is identified, appraised, selected and synthesised. However, to enable the review to be completed within a short timeframe, certain steps in the systematic review process are altered or skipped or modified or omitted!

    In order to achieve best possible outcomes to facilitate the use of RRs in decision-making and overcome the barriers of lack of timely and relevant research, a range of methods have been developed, which involve modifications to the systematic review methods.1,5,6,7 According to Khangura et al (2012), limiting the scope of RRs or having a more targeted research question is probably the most efficient shortcut because of its impact on the number of articles, including full-texts to be retrieved, screened, assessed and synthesised (including data extraction).5 However, the authors do state that it is important to engage and collaborate closely with the knowledge end-users.1,5,8 Other modifications to the traditional systematic review method include: a reduced list of sources or databases to be searched, including limiting these to specialised sources (e.g. of systematic reviews), or by date, or by language; exclusion of grey literature; relying on existing systematic reviews; full-text review limitation; the use of only one reviewer for study selection and data extraction; providing minimal conclusions or recommendations; and limiting external peer review.1,5,8

    Currently, there is no formal established methodological guidance on conducting and reporting RRs, and there is some recent work that identified a variety of approaches to RRs.4 A project work related to the extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines (for systematic reviews) for the conduct and reporting of RRs is currently underway and registered with the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network.9

    In a scoping review of RRs that compared the results of RRs to full systematic reviews (SRs) in four studies, it was found that the results reported in both the types of reviews were similar, with no incongruence.4 A rapid review in collaboration with clinical experts and/or knowledge end-users is thus a useful tool for assisting clinicians and policy decision-makers to identify evidence-based strategies for implementation into practice and to identify future research priorities.

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    References:

    1. Khangura S, Polisena J, Clifford TJ, Farrah K, Kamel C. Rapid review: an emerging approach to evidence synthesis in health technology assessment. Int J Technol Assess Health Care. 2014; 30(1):20-7.
    2. Featherstone RM, Dryden DM, Foisy M, Guise JM, Mitchell MD, Paynter RA, et al. Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews. Systems Review. 2015; 4(50).
    3. Munn Z, Lockwood C, Moola S. The Development and Use of Evidence Summaries for Point of Care Information Systems: A Streamlined Rapid Review Approach. Worldviews Evid Based Nurs. 2015 Jun; 12(3):131-8.
    4. Tricco AC, Antony J, Zarin W, Strifler L, Ghassemi M, Ivory J, et al. A scoping review of rapid review methods. BMC Medicine. 2015; 13(224).
    5. Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Systems Review. 2012; 1(10).
    6. Polisena J, Garrity C, Kamel C, Stevens A, Abou-Setta AM. Rapid review programs to support health care and policy decision making: a descriptive analysis of processes and methods. Syst Rev. 2015; 4:26.
    7. Ganann R, Ciliska D, Thomas H. Expediting systematic reviews: methods and implications of rapid reviews. Implement Sci. 2010; 5:56.
    8. Haby MM, Chapman E, Clark R, Barreto J, Reveiz L, Lavis JN. What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review. Health Res Policy Syst. 2016; 14: 83.
    9. The EQUATOR network 2015, PRISMA-RR 2017: an extension to PRISMA for rapid reviews, Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network, Centre for Statistics in Medicine, NDORMS, University of Oxford, London. 

    Written By – Dr. Sandeep Moola (Research Fellow, The University of Adelaide, Australia)

    MarksMan Healthcare

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