Article type
Year
Abstract
Background
To facilitate evidence-informed decisions for patients, clinicians and policy makers, systematic reviews of screening should address both their benefits and harms.
Objective
To investigate if Cochrane reviews and protocols that assess screening interventions address their major harms.
Method
We performed a systematic search for Cochrane reviews and protocols that assess screening interventions and investigated whether these addressed their major harms. Two authors independently screened titles and abstracts, assessed full-texts, and extracted data from included reviews and protocols. For each review or protocol, two authors judged whether each pre-defined harm was relevant. When the harm was judged as of questionable relevance, the review or protocol was excluded from the denominator in our calculations.
Results
Forty-one reviews and 5 protocols were included. Overdiagnosis was addressed in 6 of 39 (15%), overtreatment in 7 of 42 (17%) and psychosocial consequences in 29 of 46 (63%) of reviews and protocols where this was judged relevant. When data on harms were reported, they were generally not treated with the same methodological rigour as the benefits; they lacked assessment of risk of bias or certainty of the evidence. Further, about half of the Abstracts, Plain Language Summaries, and Summary of Findings tables did not include any harms.
Conclusion
The underreporting of harms of screening interventions in Cochrane reviews and protocols likely reflect primary research and is problematic from an individual and organisational perspective. We call for broad collaboration to develop reporting guidelines and core outcome sets for primary studies and systematic reviews of screening interventions. To not risk that such guidelines will constitute a bureaucratic barrier to timely publication of up-to-date evidence, editors and authors of Cochrane reviews should have an active role in this work to make sure that the practical challenges they will face are addressed. Further, we believe it is of great importance that such reporting guidelines are derived through a broad consensus process with representation of the public, clinicians, policy makers, methodologists, medical ethicists, as well as people from outside of medicine (for example social sciences and economics). These should all be free from conflicts of interests in relation to screening interventions.
Patient or healthcare consumer involvement:
No patient or healthcare consumer was involved in this work.
To facilitate evidence-informed decisions for patients, clinicians and policy makers, systematic reviews of screening should address both their benefits and harms.
Objective
To investigate if Cochrane reviews and protocols that assess screening interventions address their major harms.
Method
We performed a systematic search for Cochrane reviews and protocols that assess screening interventions and investigated whether these addressed their major harms. Two authors independently screened titles and abstracts, assessed full-texts, and extracted data from included reviews and protocols. For each review or protocol, two authors judged whether each pre-defined harm was relevant. When the harm was judged as of questionable relevance, the review or protocol was excluded from the denominator in our calculations.
Results
Forty-one reviews and 5 protocols were included. Overdiagnosis was addressed in 6 of 39 (15%), overtreatment in 7 of 42 (17%) and psychosocial consequences in 29 of 46 (63%) of reviews and protocols where this was judged relevant. When data on harms were reported, they were generally not treated with the same methodological rigour as the benefits; they lacked assessment of risk of bias or certainty of the evidence. Further, about half of the Abstracts, Plain Language Summaries, and Summary of Findings tables did not include any harms.
Conclusion
The underreporting of harms of screening interventions in Cochrane reviews and protocols likely reflect primary research and is problematic from an individual and organisational perspective. We call for broad collaboration to develop reporting guidelines and core outcome sets for primary studies and systematic reviews of screening interventions. To not risk that such guidelines will constitute a bureaucratic barrier to timely publication of up-to-date evidence, editors and authors of Cochrane reviews should have an active role in this work to make sure that the practical challenges they will face are addressed. Further, we believe it is of great importance that such reporting guidelines are derived through a broad consensus process with representation of the public, clinicians, policy makers, methodologists, medical ethicists, as well as people from outside of medicine (for example social sciences and economics). These should all be free from conflicts of interests in relation to screening interventions.
Patient or healthcare consumer involvement:
No patient or healthcare consumer was involved in this work.