Dissertation (Doctoral) The Development and Pilot Test of a Shortened Systematic Review Format for Use by Physicians

Author

Laure Anne Perrier

Abstract

There have been great advances in refining the methods of conducting and reporting systematic reviews, however they are used infrequently by practitioners in making clinical decisions. Contextualization, format, and presentation of systematic reviews have been given little attention in the literature thus leaving a gap in what is known about these attributes. Graham’s Knowledge to Action process for knowledge translation was used as a theoretical framework in the development of two shortened formats for the presentation of research evidence from systematic reviews for use in decision making by clinicians. Within the Knowledge to Action process, the tailoring of knowledge is represented as a Knowledge Funnel which includes Knowledge Synthesis and the creation of Knowledge Products and Tools. This PhD project was composed of three phases. In Phase One, a systematic review was conducted to examine the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by clinicians. There was insufficient evidence identified from this systematic review to identify key aspects of strategies that encouraged clinicians to use systematic reviews in decision making. Similarly, no alternate formats for systematic reviews that had been rigorously developed and evaluated were identified in this systematic review. Phase Two involved a multi-component process that began with creating a prototype that employed user-centered design principles, which focus on making tools that are usable, useful, and accessible. This component was followed by a mapping exercise to identify obstacles described by clinicians in using clinical evidence in decision-making, a heuristic evaluation by an expert in human factors engineering (a usability inspection method), and a review of the clinical content in the prototypes. Iterative focus groups were then conducted with physicians who provided input on the refinement of the two prototypes. Their feedback guided changes to the format, presentation, and layout of the prototypes in order to increase uptake for end-users. Phase Three was composed of usability testing of the two prototypes by clinicians and a pilot randomized trial. Iterative usability testing offered essential insight into aspects that required modifications, and alterations were made in order to create finalized versions of the two shortened systematic review formats. A pilot randomized trial was then conducted to test methods and procedures in order to refine the processes for a larger scale randomized controlled trial, which will determine the impact of the two distinct shortened systematic review formats compared with a traditional full-length systematic review on generalist physicians’ understanding of evidence and ability to apply it to a patient in a clinical scenario.


Supervisor

Sharon E Straus