Enhancing the acceptance and implementation of summary of findings tables in Cochrane Reviews: two non-inferiority randomized controlled trials

Article type
Authors
Carrasco-Labra A1, Brignardello-Petersen R2, Carrasco-Labra NS1, Mustafa R3, Etxeandia-Ikobaltzeta I4, Schünemann H1
1McMaster University, Canada
2University of Toronto, Canada
3University of Missouri-Kansas City, USA
4OSTEBA, Spain
Abstract
Background:
Although systematic reviews represent important tools for knowledge translation, users struggle with understanding and interpreting their results. GRADE summary of findings (SoF) tables have been developed to display results of reviews in a concise and transparent manner. However, it has been suggested that additional methods to present risks and display review results in the SoF tables are needed.

Methods/design:
We conducted two non-inferiority parallel, two-armed randomized controlled trials to determine whether alternative formats to present risks and display SoF tables were not inferior compared to the current standard formats (Table 1). We measured participant understanding, accessibility of the information, satisfaction and preference for either formats. We invited systematic review users to participate (i.e. clinicians, guideline developers and researchers). For the outcome understanding, the non-inferiority boundary was a 10% difference in the proportion of participants answering a given question correctly.

Results:
Participants allocated to the alternative formats had a higher understanding than participants allocated to the current formats. The presentation of risk differences (95% CI -0.66 to -0.36) and the 'what happens' column (95% CI -0.66 to 0.04) showed to be non-inferior regarding understanding compared to the current formats tested. Alternative items also showed to be more accessible overall (Mean Difference (MD) 0.3; SE 0.11, P value=0.001) and assisting decision making (MD 0.5; SE 0.18, P value=0.011). Participants from both groups strongly preferred the SoF table showing alternative formats.

Conclusions:
These trials provide systematic review authors and users with a series of alternative items that can be used along with the current formats of SoF tables. Some of these items have proven to be at least as effective as the current formats, with higher accessibility of information and preference from systematic review users.