Article type
Year
Abstract
Background: Developing the clinical pathway of a medical test can help test accuracy review authors define more precisely the target condition and study eligibility criteria for their reviews. Such pathways also help in understanding the impact of testing on clinical management decisions and ultimately the impact on patient outcomes. Describing the clinical pathway is a recent mandatory requirement in Cochrane diagnostic test accuracy (DTA) reviews but there is no explicit guidance on how to create such a pathway.
Objectives: To investigate how authors of Cochrane DTA Review protocols described the clinical pathway in their reviews.
Methods: We searched the Cochrane Database of Systematic Reviews for all DTA review protocols published between 2014 and March 2015. We checked if the pathways fulfilled a set of minimum criteria adapted from the analytical pathway as published in the Agency for Healthcare Research and Quality’s medical test manual.
Results: We found a total of 31 protocols. All addressed the clinical pathway differently, both in content and format. Most (n = 26) provided only a textual description. Four included both a visual and textual description, and one only a visual description. A detailed analysis of the 10 most recent protocols showed tremendous variation in these pathways (Table 1). The majority did not put the tests in the context of previous or further testing, clinical management following the test(s) or the impact on patient outcomes. In case of single test evaluations, downstream consequences of introducing the test were often not compared to the consequences of not testing.
Conclusions: In Cochrane DTA Review protocols there is remarkable variation in interpretation, content and format of the clinical pathway. Review authors could benefit from guidance on how to create pathways to guide them in their evidence selection and ultimately put that evidence in context of downstream patient and/or management consequences.
Objectives: To investigate how authors of Cochrane DTA Review protocols described the clinical pathway in their reviews.
Methods: We searched the Cochrane Database of Systematic Reviews for all DTA review protocols published between 2014 and March 2015. We checked if the pathways fulfilled a set of minimum criteria adapted from the analytical pathway as published in the Agency for Healthcare Research and Quality’s medical test manual.
Results: We found a total of 31 protocols. All addressed the clinical pathway differently, both in content and format. Most (n = 26) provided only a textual description. Four included both a visual and textual description, and one only a visual description. A detailed analysis of the 10 most recent protocols showed tremendous variation in these pathways (Table 1). The majority did not put the tests in the context of previous or further testing, clinical management following the test(s) or the impact on patient outcomes. In case of single test evaluations, downstream consequences of introducing the test were often not compared to the consequences of not testing.
Conclusions: In Cochrane DTA Review protocols there is remarkable variation in interpretation, content and format of the clinical pathway. Review authors could benefit from guidance on how to create pathways to guide them in their evidence selection and ultimately put that evidence in context of downstream patient and/or management consequences.