What do clinicians understand and how do they interpret results from network meta-analysis and the way they are presented?

Article type
Year
Authors
Del Giovane C1, Filippini G2, Tramacere I2, D'Amico R1
1Cochrane Italy, University of Modena and Reggio Emilia, Italy
2Multiple Sclerosis and Rare Diseases of the CNS Cochrane Group, Istituto Neurologico Carlo Besta, Italy
Abstract
Background: Network meta-analysis (NMA) provides a summary of the evidence available in the literature about the efficacy and safety of health interventions. Since results from NMA are used by health professionals to make decisions, it is important that this method is properly understood and recognized by them.

Objectives: To investigate how clinicians understand and interpret the results from NMA and the way they are presented.

Methods: The assessment was carried out through an online national survey from October 2015 to January 2016 (www.statisticamedica.unimore.it/encore-ms/). The survey considered multiple sclerosis (MS) as the condition and involved neurologists as representatives of clinicians. The questionnaire was based on results and figures from a NMA on treatments for MS recently published on the Cochrane Library (Tramacere 2015).

Results: Forty-one neurologists participated in the survey and 22 completed it. Fifty-four per cent of responders considered the results from NMA useful. Among different ways of representing results (see the attachment), neurologists preferred the graph displaying the treatment effects by horizontal segments (36% of responders, Figure 5), followed by table (27%, Figure 3) and the graph with vertical bars (14%, Figure 4). Fourteen per cent of them would not use any type of representation presented. The type of representation mostly indicated by neurologists to be used to inform people with MS about available interventions and their efficacy was the graph with vertical bars (32% of responders, Figure 4) followed by the graph with horizontal segments (23%, Figure 5).

Conclusions: Neurologists considered the outputs from NMA useful and important when deciding which treatment to use for MS. A different representation of results should be used for presenting them to patients.

Tramacere I, Del Giovane C, Salanti G, D’Amico R, Filippini G.Immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis: a network meta-analysis. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011381. DOI: 10.1002/14651858.CD011381.pub2