Issues in using, interpreting, and presenting patient-reported outcomes in Cochrane Reviews

Article type
Devji T1, Patrick D2, Guyatt G1
1McMaster University
2University of Washington
Systematic reviews and meta-analyses of randomized trials that include patient reported outcomes measures (PROMs) provide crucial information for patients and clinicians facing challenging healthcare decisions. Based on emerging methods, guidance on combining PROMs in meta-analyses and interpreting results is likely to enhance their usefulness for decision-makers.

In the context of 'Summary of findings' tables in Cochrane Reviews, participants will be able to:
1) identify the issues in retrieving, analyzing, and interpreting patient-reported outcome (PRO) results in clinical trials;
2) discuss preferred alternatives with emphasis on the minimal important difference (MID) for aggregating across different PRO instruments measuring the same construct;
3) describe how to retrieve MIDs and introduce the concept of judging the credibility of the estimates;
4) present PRO results in the 'Summary of findings' table.

This workshop will use interactive lecture with questions to participants and small group discussion to address the challenges in including and interpreting PROs in Cochrane Reviews. Potential solutions will be explored in analyzing and making patient-reported outcome readily understandable to the audience of Cochrane review authors. These challenges involve making decisions on interpreting magnitude of effect (are differences trivial, small but important, or large?). We will briefly introduce approaches to aggregating across different instruments measuring the same construct with emphasis on the concept of the MID (the smallest difference that would motivate a patient to use an intervention), and allow the dichotomization of continuous outcomes (e.g. the proportion of patients who achieve a MID). We will introduce the concept of evaluating the credibility of MIDs. During the workshop, issues that arise will be discussed in breakout groups. At the end of each of these breakout sessions, each group will report back with the group's conclusions. This workshop will prepare participants for a second workshop that will focus on the methods for evaluating credibility and application of presentations approaches that rely on the MID in systematic reviews and guidelines.