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Finding What Works in Health Care: Standards for Systematic Reviews
their study methods (Devereaux et al., 2004).1 If SRs are poorly reported, patients and clinicians have difficulty determining whether an SR is trustworthy enough to be used to guide decision making or the development of clinical practice guidelines (Moher et al., 2007). High-quality SR reports summarize the methodological strengths and weaknesses of the SR and include language designed to help nonexperts interpret and judge the value of the SR (AHRQ, 2010b; CRD, 2010a; Higgins and Green, 2008; Liberati et al. 2009; Moher et al. 2009). However, according to an extensive literature, many published SRs inadequately document important aspects of the SR process (Delaney et al., 2005, 2007; Golder et al., 2008; McAlister et al., 1999; Moher et al., 2007; Mulrow, 1987; Roundtree et al., 2008; Sacks et al., 1987). A seminal study conducted by Mulrow, for example, assessed 50 review articles published in four leading medical journals and found that many reviews failed to report the methods of identifying, selecting, and validating information, and choosing areas for future research (Mulrow, 1987). More recently, Moher and colleagues (2007) evaluated 300 SRs indexed in MEDLINE during November 2004. They concluded that information continues to be poorly reported, with many SRs failing to report key components of SRs, such as assessing for publication bias, aspects of the searching and screening process, and funding sources. Other studies have found that SRs published in journals often inadequately report search strategies, validity assessments of included studies, and authors’ conflicts of interest (Delaney et al., 2005; Golder et al., 2008; Roundtree et al., 2008).
Authors of all publicly sponsored SRs must produce a detailed final report, which is typically longer and more detailed than the version submitted for journal publication. The sponsor typically publishes the final report on its website, where it stands as the definitive documentation of the review. The standards recommended by the committee apply to this definitive comprehensive final report. The committee recommends three standards for producing a comprehensive SR final report (Box 5-1), including standards for documenting the SR process, responding to input from peer reviewers and other users and stakeholders, and making the final reports publicly available. Each standard includes elements of performance that the committee deems essential. The evidence base for developing standards for the final report is sparse. In addition, most evaluations of the quality of published SRs have focused on
See Chapter 3 for a review of the literature on reporting bias and dearth of adequate documentation in most SRs of comparative effectiveness.