Priority setting

Background

At CDCIG, we identify priorities for our work in line with Cochrane’s Strategy to 2020, Goal 1: Producing Evidence, and particularly the following objectives for evidence production:

Relevant 2. We will engage with patients and other healthcare consumers, health practitioners, policy makers, guidelines developers and research funders to identify questions that are most relevant and important to them; and prioritize the production and updating of Cochrane Systematic Reviews accordingly.

Up-to-date 3. We will ensure that Cochrane Systematic Reviews represent the best evidence currently available by establishing and managing performance against updating targets, particularly for high priority reviews.

Wide coverage 4. We will continue to support the production of Cochrane Systematic Reviews across a broad range of questions in order to develop the widest possible body of reliable knowledge about health.

Pioneering methods 5. We will ensure that established methods are applied consistently and appropriately in Cochrane Systematic Reviews; and continue to develop innovative methods for designing and conducting research evidence synthesis that help us to achieve our mission.

Responsibilities

  • Our priority-setting activities are led by a steering group consisting of the Coordinating Editors and Deputy Coordinating Editor. This group is responsible for producing and maintaining a priority-setting plan. The steering group takes advice from the Editorial Board.
  • The members of the steering group will report on priority-setting activities annually in the report to the group’s funder, the NIHR.
  • The Managing Editor will ensure that priority-setting (progress of priority-setting projects, need for new priority-setting activities) is a standing item on the agenda for editorial meetings and board meetings in order that it is considered in all of the group’s decision-making.
  • The Managing Editor will ensure that priority-setting activities are appropriately publicised on the group’s website.

Methods used to identify priorities

Recognising that the group has limited editorial resources, the following factors will be considered when deciding which new titles to develop and which existing reviews to update:

1. Data on citation, access and downloads of existing reviews provided annually by Wiley, and Altmetric data on social media impact;
2. Data on use of reviews in guidelines;
3. Published prioritisation exercises relevant to the group’s scope, if conducted using adequate methods;
4. Direct consultations with stakeholders, who may be organisations representing patients and/or carers, guideline developers, professional associations or other relevant bodies;
5. Periodic scoping searches for new evidence relevant to existing reviews potentially in need of updating;
6. Advice from the group’s editorial board (multidisciplinary, international);
7. Evidence provided by prospective author teams with title proposals;
8. The group’s strategic plans for extending scope into new review methods or topic areas;
9. Opportunity to develop the skills and experience of editors and authors;
10. In the case of novel methods, availability of appropriate methodological support;
11. Exceptional circumstances requiring a rapid response, e.g. the Covid-19 pandemic;
12. Feedback from NIHR on the group’s business plans.

Recent priority-setting activities completed

1. Systematic review of dementia priority-setting exercises
When identifying priority titles in recent years, we have been very mindful of the James Lind Alliance UK priority-setting partnership work. However, their dementia exercise was completed some time ago (2013) and we recognised that other research priority setting exercises have been completed since then. To address this, we have recently completed a systematic review of all published dementia priority-setting work.

2. Direct stakeholder consultations: delirium and vascular cognitive impairment
We identified delirium as a topic area where our reviews were highly cited and accessed. We also identified vascular cognitive impairment as an area in which the portfolio could be updated and extended. To engage with stakeholders, in 2021 we designed and circulated short questionnaires through two professional organisations, namely the European Delirium Association and OPSYRIS – Organisation for Psychological Research in Stroke. The purpose of these consultations was two-fold: to identify high priority titles (new reviews or updates) and to prioritise methods for the group to develop (e.g. prognostic, qualitative). 

3. Scoping searches
In 2016-17, we completed scoping searches for all the reviews in our portfolio in order to identify areas of continuing research activity. As a result of this exercise, we were able to focus our ongoing prioritisation work by identifying which reviews were no longer in need of updating or were very low priority for updating because they concerned topics which were no longer of clinical or research interest.

4. Carer involvement in prioritisation of outcomes
In a slightly different vein, in 2019 we worked with the Alzheimer’s Society (UK) to involve family carers of people with dementia in the prioritisation of outcomes within a review on the treatment of sleep problems in dementia. An account of the methods and outcomes of this project is available here.

Summary of two recent priority setting exercises in focussed areas 

We are keen to develop more reviews in the fields of delirium and vascular dementia. As part of our priority setting in these areas, we thought it would be useful to ask clinicians and researchers for their views. 

We developed a questionnaire on priority topics in delirium and vascular cognitive impairment (VCI). The reviews asked for feedback on updating existing titles, potential new titles and the review methods of greatest interest. For most questions we asked respondents to rank a list of options, but we also allowed space for free text responses. 

To ensure dissemination, we were fortunate to be invited to work with two international professional societies:  EDS (European Delirium Society) and OPSYRIS (Organisation for Psychological Research in Stroke).  

Both groups helped raise visibility of our questionnaires on social media and distributed the questionnaire at their 2019 annual conferences. 

The response to both priority setting exercises was really encouraging and we are thankful to EDS and OPSYRIS for their support. Below we offer our interpretation of the questionnaire responses and free text feedback. We will also describe how we are using these data.

1) OPSYRIS (Organisation for Psychological Research in Stroke)  Annual meeting, Oxford 2019

The vascular cognitive impairment researchers that responded were interested in reviews describing the efficacy of drug treatments (including de-prescribing) and psychological interventions. Reviews of alternative or complementary treatments were less favoured. Based on these data we allocated 2020 editorial team resource to completing a review on antithrombotic medications for preventing cognitive decline in cerebrovascular disease. 

While traditional comparative review methods, including network reviews, remain most popular there was a recognition of the importance of test accuracy and prognosis. Qualitative review methods were not favoured.  Based on the responses we prioritised completing of our first network meta-analysis which had a VCI theme. We also continued to upskill our core editorial team in prognosis methods and hope to apply these methods to our next prognostic review title. 

The free text responses suggested that our next reviews should consider care-givers and short cognitive screening tests used in stroke care. We are developing potential new titles in these areas. For further details please see the results of the questionnaire.

2) European Delirium Society Annual meeting, Edinburgh 2019 

The delirium community favoured reviews looking at non-pharmacological or complex interventions and saw value in reviews of prevention as well as treating established delirium. Reviews on single drug treatments were less favoured. Based on these responses we are prioritising an update of our review on multicomponent delirium prevention. 

Our plans to upskill in prognosis reviews are supported by the feedback, although comparative reviews of interventions remain a priority. Qualitative reviews were seen as less important. We will continue to develop methodological expertise in prognosis evidence synthesis to allow us to apply this method to delirium research. 

There were specific examples of review topics that we could take forward – for example lots of people wanted a review on accuracy of short delirium screening tools. The feedback also suggested clinical settings (care-homes), interventions (withdrawal) and populations (care-givers) that we should give more attention. We are currently formulating a title on anticholinergic medication deprescribing in care-homes that will look at incident delirium as an outcome and include care-giver outcomes. For further information please see the results of the questionnaire.

Current priority-setting plan

Identifying priorities in care homes

The group’s funder, NIHR, made a specific request for increased engagement with care homes in our plan for 2020-23. Therefore, we have initiated a consultation exercise with care homes. This was initially planned for 2020, but due to the unprecedented challenges facing care homes in this period, the exercise will be extended into 2021.