The EBM library signposts some essential reading for the practice of Evidence-Based Medicine. In this part of the library, we highlight papers that reflect the role of systematic reviews in policymaking.
Kamal R. Mahtani
One of the purposes of conducting systematic reviews is to provide accessible evidence to inform clinical decisions. In healthcare, they may target patients, clinicians, managers, and policymakers. Increasing their uptake for policymaking brings particular challenges. Many studies have explored these challenges, so If this is a topic of interest, I would recommend starting with the papers highlighted in this series which describe why these challenges arise and how they may be overcome.
Paper 1: Whitty, Christopher JM. “What makes an academic paper useful for health policy?” BMC Med 2015; 13(1): 301.
Everyone interested in the role of systematic reviews in policymaking should read this essay, from the UK Chief Scientific Officer, Chris Whitty. He outlines the key components that make research evidence more relevant to policymakers and states that “Way ahead of any other academic contribution to policy-making is rigorous and unbiased synthesis of current knowledge.” However, he goes on to highlight the need for breadth in the types of synthesis needed, moving beyond traditional “what works” reviews. He throws down a gauntlet by stating that “If the academic community as a whole could do one thing to improve the pathway from research to policy, it would be to improve the status, quality and availability of good synthesis.” So systematic reviews, certainly the broader forms of synthesis, should be of high relevance to policymakers when done right.
Paper 2: Lavis J, Davies H, Oxman A, Denis JL, Golden-Biddle K, Ferlie E. Towards systematic reviews that inform health care management and policy-making. Journal of Health Serv Res & Policy 2005; 10(Suppl 1): 35-48.
Lavis and colleagues undertook an exploratory study “to identify ways in which researchers and research funders could improve the usefulness of systematic reviews for healthcare managers and public policy-makers”. They began by conducting a systematic review that asked: what factors influence the use of research evidence in decision-making by healthcare managers and healthcare policy-makers? They identified 17 relevant studies, of which they found that the main factors that influence the uptake of systematic reviews by policymakers are: greater interactions between researchers and health care policymakers, timing of the reviews, policymakers’ attitudes towards research evidence, and their skills, expertise, and understanding.
They also conducted interviews with healthcare managers and policy makers, exploring how researchers could make systematic reviews more accessible to them. Policymakers and managers appear to be just as interested in knowing the answers to the “what works?” type questions, as they are in answers to how programmes may fit into local contexts and how to influence change. Systematic reviews that provide information on benefits, harms and cost implications are useful, as are reviews that provide information on the uncertainty of estimates. The way systematic reviews were formatted and presented to policymakers was also an emergent theme, with a suggestion that systematic reviews could be presented using a 1:3:25-page format (1-page summary, 3-page brief, 25-page detailed review). Other conclusions can be drawn from their findings, so definitely worth a read.
In the next blog of the series, I shall highlight two further papers. The first systematically reviews the evidence for interventions that encourage uptake of systematic reviews by policymakers. The second paper explores the barriers to and facilitators of uptake to policymakers.
Kamal R Mahtani is a GP and deputy director of the Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford. He is also the director of the evidence-based healthcare MSc in systematic reviews.
You can follow him on Twitter @krmahtani
Disclaimer: The views expressed in this commentary represent the views of the author and not necessarily those of his host institution, the NHS, the NIHR, or the Department of Health.
Acknowledgements: Jeffrey Aronson for helpful discussions.
Competing interests: Kamal Mahtani receives funding from the NIHR SPCR for the Evidence Synthesis Working Group and is Director of a MSc in Systematic reviews