Putting the issues on the table: summarising outcomes from reviews of reviews to inform health policy

Article type
Authors
Brunton G1, Thomas J1, Paraskeva N2, Caird J1, Rumsey N2
1EPPI Centre, Social Science Research Unit, Institute of Education, University of London
2Centre for Appearance Research, University of the West of England, Bristol
Abstract
Background: Systematic reviews are increasingly used to inform health policy. These often employ rapid evidence assessment methods, involving reviews of reviews. Together, these result in particular challenges, since policy questions can be broad, and the time available more suitable for reviews with a more limited scope. Navigating these issues thoughtfully both precedes and supports a more downstream need: for knowledge translation to represent evidence in a way that is appropriate for policy use. Configurative reviews involving a qualitative comparison of consistency across reviews have been recommended, but few methods to undertake such comparisons have been reported.

Objectives: To demonstrate a novel method of representing evidence from a systematic rapid evidence assessment (SREA).

Methods: We undertook a SREA of cosmetic interventions which asked a broad research question under tight timelines. As a review of reviews supplemented by primary studies where review evidence was thin, statistical synthesis was not appropriate. Instead, we mapped in tabular format the effects (positive/no change/negative) for each outcome against each type of cosmetic intervention. We then compared overall effects by each cosmetic procedure and each outcome, to derive a narrative synthesis of effectiveness.

Results: The tabular format (Table 1) illustrated the impact of cosmetic interventions on each outcome (e.g. satisfaction, self-esteem, anxiety etc.). It also allowed visualisation of the overall impact (i.e. all outcomes) of any one cosmetic intervention. These produced very different Results: for example, self-esteem improves across cosmetic interventions, but findings across abdominoplasty studies suggest small or no improvements across outcomes.

Conclusions: This type of cross-tabulation adds depth to the SREA process since evidence on narrower (i.e. procedure-specific) interventions can be summarised visually to address broader policy questions of effectiveness while showing overall effectiveness. The use of systematic reviews enabled us to conduct a rigorous evidence synthesis within the limited policy timescale.