Article type
Year
Abstract
Background:
Cochrane authors may not be choosing the most appropriate outcomes for their reviews. A survey conducted in 2013 found that Cochrane users disagreed with the review authors’ selection of primary outcomes 71% of the time. Participants indicated the authors’ selection did not reflect the most important outcomes. One root of this problem may occur during outcome selection in randomized controlled trials (RCTs).
Objectives:
A specific hierarchy of outcomes for Cochrane review authors would serve to create essential knowledge for Cochrane consumers with respect to the benefit versus harm of an intervention.
Methods:
A number of 'worst case scenarios' are explored in order to learn from previous, harmful mistakes. Drawing on evidence in Therapeutics Letters that use Cochrane methods to assess treatment outcome, we point out where flaws occur in outcome selection of RCTs and discuss how a specific hierarchy of outcomes could increase the value and impact of Cochrane Reviews.
Conclusions:
A focus on key patient outcomes within a specific hierarchy allows assessment of net treatment benefits. This attention to outcome hierarchies, rather than a dichotomized approach that separates expected beneficial from unexpected harmful effects, could greatly benefit systematic review methodology.
Cochrane authors may not be choosing the most appropriate outcomes for their reviews. A survey conducted in 2013 found that Cochrane users disagreed with the review authors’ selection of primary outcomes 71% of the time. Participants indicated the authors’ selection did not reflect the most important outcomes. One root of this problem may occur during outcome selection in randomized controlled trials (RCTs).
Objectives:
A specific hierarchy of outcomes for Cochrane review authors would serve to create essential knowledge for Cochrane consumers with respect to the benefit versus harm of an intervention.
Methods:
A number of 'worst case scenarios' are explored in order to learn from previous, harmful mistakes. Drawing on evidence in Therapeutics Letters that use Cochrane methods to assess treatment outcome, we point out where flaws occur in outcome selection of RCTs and discuss how a specific hierarchy of outcomes could increase the value and impact of Cochrane Reviews.
Conclusions:
A focus on key patient outcomes within a specific hierarchy allows assessment of net treatment benefits. This attention to outcome hierarchies, rather than a dichotomized approach that separates expected beneficial from unexpected harmful effects, could greatly benefit systematic review methodology.