When lack of evidence informs policy and the public debate: experiences from a systematic review on shared physical custody

Article type
Authors
Blaasvær N1, Nøkleby H1
1The Norwegian Institute of Public Health
Abstract
Background: Systematic reviews often include few or no studies, or studies of low quality, so the findings are uncertain. This can be a disappointing result for commissioners. In 2016, the Norwegian Directorate for Children, Youth and Family Affairs commissioned the Norwegian Institute of Public Health to synthesize research on the effects of shared physical custody for children. Early on, the review group realized that the report would not allow us to draw firm conclusions about the effects of shared custody, due to the nature of the question, inclusion criteria, methods and application of GRADE. Yet, we believed that it was important to write a report that could contribute to the discussion and would be useful.

Objectives:
1) Write a report that is useful to the interest groups within the area even though the evidence was thin and the effect uncertain.
2) Visit the different interest groups after publishing the report to explore if it was useful to them and why.

Methods: We took time early in the project to familiarize ourselves with the topic and debates in the field of shared physical custody. In dialogue with the commissioner, experts and parents' groups we chose to write a report that explained the topic, the debate, the existing research and our evaluation of it, as well as discussing the different implications due to the uncertainty of the evidence.
After the report was delivered we visited decision makers, professionals working hands-on with families, and parents' groups, to explore how they were interpreting and using our findings. We also conducted a simple analysis of the media debate before and after publishing the report.

Results and Conclusions: Systematic reviews that arrive at findings with a large degree of uncertainty in the evidence can contribute, nonetheless, to debate and be useful to stakeholders. The feedback from the different interest groups was that the report helped to clear up misunderstandings, and stakeholders now had an agreed platform from which to discuss implications for practice. The report has been a foundation for new guidelines for decision makers.

Patient or healthcare consumer involvement: We worked closely with different interest groups throughout the report process. We also participated in a number of debates and conferences with the commissioner to discuss research in this field.