Article type
Year
Abstract
Background: Systematic reviews are increasing in number, and groups including the Institute of Medicine (IOM) emphasize the importance of attention to financial conflicts of interest. Little guidance exists, however, on how to manage the risk of bias for systematic reviews (SRs) from nonfinancial conflicts of interest (NFCOI) such as strongly held beliefs, personal relationships, and desire for career advancement.
Objectives: To provide practical guidance on ensuring adequate clinical or content expertise while maintaining independence of judgment on SR teams by (1) defining NFCOI as it applies to SR teams, (2) developing guidance and an instrument to identify, characterize, and manage NFCOI, and (3) improve transparency of judgment regarding NFCOI for users of reviews.
Methods: Fourteen workgroup members reviewed existing international guidance on managing conflicts, built on these approaches to define NFCOI, and developed practical guidance in the form of an instrument and examples for each potential source of conflict.
Results: Our definition of NFCOI in the context of systematic reviews builds on the broader IOM definition of conflict of interest. In our instrument, we propose questions for funders and SR principal investigators to evaluate whether the SR topic is subject to intense advocacy, active policy debate, large interspecialty variations, and limited availability of clinical or content expertise. Responses to these contextual questions can serve as a guide to creating an SR team that appropriately balances critical clinical and content expertise with independence of judgment. Once the team is assembled, we suggest additional questions on personal beliefs, previously published opinions, institutional relationships, and career advancement. We also propose a range of approaches to managing identified conflicts.
Conclusions: This work is a consensus effort attempting to achieve a balance between supplying needed expertise and minimizing NFCOI. However, the utility of this approach and barriers to implementation must be investigated.
Objectives: To provide practical guidance on ensuring adequate clinical or content expertise while maintaining independence of judgment on SR teams by (1) defining NFCOI as it applies to SR teams, (2) developing guidance and an instrument to identify, characterize, and manage NFCOI, and (3) improve transparency of judgment regarding NFCOI for users of reviews.
Methods: Fourteen workgroup members reviewed existing international guidance on managing conflicts, built on these approaches to define NFCOI, and developed practical guidance in the form of an instrument and examples for each potential source of conflict.
Results: Our definition of NFCOI in the context of systematic reviews builds on the broader IOM definition of conflict of interest. In our instrument, we propose questions for funders and SR principal investigators to evaluate whether the SR topic is subject to intense advocacy, active policy debate, large interspecialty variations, and limited availability of clinical or content expertise. Responses to these contextual questions can serve as a guide to creating an SR team that appropriately balances critical clinical and content expertise with independence of judgment. Once the team is assembled, we suggest additional questions on personal beliefs, previously published opinions, institutional relationships, and career advancement. We also propose a range of approaches to managing identified conflicts.
Conclusions: This work is a consensus effort attempting to achieve a balance between supplying needed expertise and minimizing NFCOI. However, the utility of this approach and barriers to implementation must be investigated.