Background: The traditional approach to presenting the results of systematic reviews is to use multiple summary tables. Although highly informative, these tables are often dense and do not allow a reader to evaluate the evidence on various and outcomes “at a glance” and instead require large parts of the publication to be read. Since they can easily and clearly illustrate cause and effect, fishbone diagrams are widely used in industrial studies and are beginning to be used in health care. The goal of this paper is to show how these diagrams can be adapted for use in graphically capturing the results of systematic reviews in health care research, and to stimulate further consideration of pictorial summary approaches.
Methods: We applied the fishbone diagram to summarize the findings from a sample of systematic reviews visually. The head of the fish represents the balance of benefits and harms of an intervention or comparison, and the bones of the fish represent the individual health outcomes or moderators. To illustrate a range of applications, we abstracted and compiled information from the summary tables of three recent systematic reviews to populate each fishbone diagram.
Results: Based on real world systematic reviews, we provide three examples that show how fishbone diagrams might be used to display complex information in a clear and succinct manner. We present fishbone diagrams depicting:
1. the body of evidence used for a clinical practice guideline;
2. the body of evidence for development of population-based screening recommendations; and
3. the relationship between an outcome and various positive and negative moderators.
Conclusions: Fishbone diagrams are compact visualizations that may prove useful for summarizing the findings of systematic reviews, especially for healthcare providers and guideline developers who do not have the time to review the full evidence in its entirety.