Living Reviews: Practical Considerations for Adapting Scope and Communicating Evolving Evidence
2Oregon Health and Science University, USA
Background: In order to maintain reliability and trustworthiness, evidence-based policies and healthcare recommendations need to keep up with emerging scientific evidence. Such up-to-date information can greatly benefit healthcare decision makers and the patients they serve. Despite their proliferation, standards to conduct living reviews are still evolving. The US Agency for Healthcare Research and Quality (AHRQ) has conducted a number of “living” reviews to evaluate and update the evidence base on interventions for chronic pain.
Objectives: To describe the methods used, challenges encountered, and strategies developed to maintain living reviews and present the evolving evidence. These include 1) adapting or expanding review scope; 2) utilizing input from stakeholders; 3) optimizing frequency and format of living updates; and 4) using data visualization and innovative methods to complement the living review reports.
Methods: The composition of the original multidisciplinary technical expert panel (TEP) was assessed during the living review update, new members added and convened to inform methodologic issues and reevaluate scope. In addition, we iteratively piloted various formats to present new evidence identified in the living review and the overall state of the science that evolved in recurring surveillance reports. We also collaborated with our agency’s web team to develop optimal displays for the reports, with the goal of upholding transparency while enhancing user experience.
Results: The literature search results signaled that new interventions might be important to include, resulting in the recruitment of new TEP members with appropriate expertise. Literature scans and TEP discussions indicated that an expansion of scope with respect to patient population and outcomes should be considered. Each quarterly surveillance report was crafted to be ‘stand-alone’, providing sufficient detail for first-time readers. We also created a summary table to describe new findings in the context of previous conclusions, with italics and bolding of text to distinguish them from prior surveillance results.
Conclusions: Our experience illustrates the value of periodically reassessing the scope of living systematic reviews to ensure that they remain useful. Presentation of frequent updates is challenging, but data visualization techniques can enhance communication of results with patients, healthcare providers and policy makers.