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 Mahtani

In part 1 of this series two papers highlighted why systematic reviews are important in policymaking, and some challenges this may bring. In this second part, we continue to look at some essential reading in the field.

Paper 3: The use of systematic reviews by health policymakers and managers: a systematic review. Implement Sci 2011; 6(1): 43.

While the Lavis study (Paper 2 in this series) looked at the ways in which systematic reviews could be more useful to policymakers, this paper evaluated interventions that increased that implementation. Despite locating over 17,000 records, Laure Perrier and colleagues identified only four studies for inclusion, three of which reported data from one study The intervention within that study entailed the distribution of five systematic reviews to public health policymakers. The recipients were then surveyed three months, and then two years later. At three months, about a quarter of the policymakers stated that the systematic reviews they received, played some part in programme planning or decision making. By two years, about two-thirds of the respondents stated that they had used at least one of the systematic reviews in making a decision. The authors rightly highlight the poor quality of the evidence they found and the paucity of evidence in the field as a whole. They also conclude that future research should examine “the circumstances and contexts under which systematic reviews are most effective.”

Paper 4: Barriers and facilitators to uptake of systematic reviews by policymakers and health care managers: a scoping review. Implement Sci 11.1 (2016): 4.

Laure Perrier’s study was followed up by a further review of the evidence. Andrea Tricco and colleagues conducted a scoping review of the barriers to and facilitators of the use of systematic reviews by healthcare managers and policymakers. Unlike a traditional systematic review, a scoping review has a different agenda, which includes the ability to map the key concepts underpinning a research area. Their search identified 19 eligible studies, the findings from which they charted in a framework that included attitudes, knowledge, skills, and behaviour. They also identified factors that affect format and content.  Facilitators that support uptake included contextualising the evidence for decision making, such as providing information on how the evidence might be useful in resource-constrained circumstances versus higher-income settings. A one page summary of the key findings also emerged, as did a simplified assessment of the findings, including the limitations of any included studies. The research highlighted the importance of summarising systematic review findings for different audiences. A valid point made by the reviewers was that journal editors should consider incorporating these different formats into their publications. There were barriers to the uptake of systematic reviews: that the reviews were not deemed relevant to policymakers and managers; that there was a lack of motivation to use them; and that there were limited skills in interpreting them. Closer partnerships between researchers and policymakers may help to overcome these barriers and build shared capacity in conducting and using systematic reviews.

Over the two blogs, we have looked at four papers exploring the importance of systematic reviews to policymakers, and the challenges that come with trying to increase their uptake. So what have we learnt? Chris Whitty’s paper enforced the belief that synthesising existing evidence was of clear importance in policymaking. However, as Lavis and colleagues highlight, researchers should consider building relationships with policymakers early on in the review process, and produce timely reviews that are presented in formats amenable to the needs of policymakers.  Laure Perrier’s study highlighted that very few interventions to increase the uptake of systematic reviews in policymaking had been evaluated, while Andrea Tricco and colleagues highlighted that they were exploring this in future research.

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