Article type
Abstract
Background:
Guideline developers and other players within the healthcare ecosystem depend on up-to-date evidence to make recommendations and decisions that can directly affect patient care. Living systematic reviews (LSRs) may appeal, as they undergo continual surveillance and are updated at regular intervals to keep conclusions up to date. In recent years, the number of published LSRs has increased dramatically. While many follow similar generally accepted guidance, the nature of the topic and literature base (eg, how quickly is the evidence evolving, how rapidly are the science or technology progressing, is a drug or device close to FDA approval?), the purpose of the review, and organizational resources may impact factors such as the frequency and methods of surveillance, expert involvement, and the frequency and form of the updates.
Objectives:
To describe the LSR topic refinement process, including consideration of key questions, scientific advancement, scope, and stakeholder involvement; creating and maintaining a forward-thinking search that balances recall with precision; surveillance, reporting, and updating
Methods:
In late 2022, we began refining a lung cancer screening LSR. Relevant key questions (KQs) relate to the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT) and the diagnostic accuracy of LDCT augmented with a medical device (ie, technology or assay). We sought feedback from primary care providers, experts in lung cancer screening research, and health equity experts. We identified a number of challenges unique to LSRs. For example, the framing of a KQ may need to capture technology or an intervention that does not yet exist—without expanding the scope unreasonably. We identified additional barriers and facilitators, many of which were resource related. To partially mitigate barriers, we placed a strong emphasis refining the search strategy at the start and developing a process to identify when our search may need to be updated.
Conclusion:
LSRs can be resource intensive, particularly early on, and especially for topics in rapidly evolving fields. However, despite the associated challenges, LSRs provide an attractive option to guideline developers who want to keep their recommendations in step with the most current scientific research and federal guidance.
Guideline developers and other players within the healthcare ecosystem depend on up-to-date evidence to make recommendations and decisions that can directly affect patient care. Living systematic reviews (LSRs) may appeal, as they undergo continual surveillance and are updated at regular intervals to keep conclusions up to date. In recent years, the number of published LSRs has increased dramatically. While many follow similar generally accepted guidance, the nature of the topic and literature base (eg, how quickly is the evidence evolving, how rapidly are the science or technology progressing, is a drug or device close to FDA approval?), the purpose of the review, and organizational resources may impact factors such as the frequency and methods of surveillance, expert involvement, and the frequency and form of the updates.
Objectives:
To describe the LSR topic refinement process, including consideration of key questions, scientific advancement, scope, and stakeholder involvement; creating and maintaining a forward-thinking search that balances recall with precision; surveillance, reporting, and updating
Methods:
In late 2022, we began refining a lung cancer screening LSR. Relevant key questions (KQs) relate to the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT) and the diagnostic accuracy of LDCT augmented with a medical device (ie, technology or assay). We sought feedback from primary care providers, experts in lung cancer screening research, and health equity experts. We identified a number of challenges unique to LSRs. For example, the framing of a KQ may need to capture technology or an intervention that does not yet exist—without expanding the scope unreasonably. We identified additional barriers and facilitators, many of which were resource related. To partially mitigate barriers, we placed a strong emphasis refining the search strategy at the start and developing a process to identify when our search may need to be updated.
Conclusion:
LSRs can be resource intensive, particularly early on, and especially for topics in rapidly evolving fields. However, despite the associated challenges, LSRs provide an attractive option to guideline developers who want to keep their recommendations in step with the most current scientific research and federal guidance.