Interpreting systematic reviews: are we ready to make our own conclusions? A cross-sectional study

BMC Medicine

Research Article

Ming Lee Lee¹  Cheong Lieng Teng²  Nai Ming Lai³ 

[1] Clinical Research Centre, Hospital Tuanku Jaafar, Jalan Rasah, 70000, Seremban, Negeri Sembilan, Malaysia;Department of Family Medicine, International Medical University, Jalan Rasah, 70000, Seremban, Negeri Sembilan, Malaysia;Department of Paediatrics, Monash University Sunway Campus, Jeffrey Cheah School of Medicine and Health Sciences, JKR 1235, Bukit Azah, 80100, Johor Bahru, Johor, Malaysia;

关键词: Medical Student;    Prior Belief;    Health Care Practitioner;    Review Author;    Answer Sheet;   

DOI  :  10.1186/1741-7015-9-30

 received in 2011-02-11, accepted in 2011-03-30,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundIndependent evaluation of clinical evidence is advocated in evidence-based medicine (EBM). However, authors' conclusions are often appealing for readers who look for quick messages. We assessed how well a group of Malaysian hospital practitioners and medical students derived their own conclusions from systematic reviews (SRs) and to what extent these were influenced by their prior beliefs and the direction of the study results.MethodsWe conducted two cross-sectional studies: one with hospital practitioners (n = 150) attending an EBM course in June 2008 in a tertiary hospital and one with final-year medical students (n = 35) in November 2008. We showed our participants four Cochrane SR abstracts without the authors' conclusions. For each article, the participants chose a conclusion from among six options comprising different combinations of the direction of effect and the strength of the evidence. We predetermined the single option that best reflected the actual authors' conclusions and labelled this as our best conclusion. We compared the participants' choices with our predetermined best conclusions. Two chosen reviews demonstrated that the intervention was beneficial ("positive"), and two others did not ("negative"). We also asked the participants their prior beliefs about the intervention.ResultsOverall, 60.3% correctly identified the direction of effect, and 30.1% chose the best conclusions, having identified both the direction of effect and the strength of evidence. More students (48.2%) than practitioners (22.2%) chose the best conclusions (P < 0.001). Fewer than one-half (47%) correctly identified the direction of effect against their prior beliefs. "Positive" SRs were more likely than "negative" SRs to change the participants' beliefs about the effect of the intervention (relative risk (RR) 1.8, 95% confidence interval 1.3 to 2.6) and "convert" those who were previously unsure by making them choose the appropriate direction of effect (RR 1.9, 95% confidence interval 1.3 to 2.8).ConclusionsThe majority of our participants could not generate appropriate conclusions from SRs independently. Judicious direction from the authors' conclusions still appears crucial to guiding our health care practitioners in identifying appropriate messages from research. Authors, editors and reviewers should ensure that the conclusions of a paper accurately reflect the results. Similar studies should be conducted in other settings where awareness and application of EBM are different.Please see Commentary: http://www.biomedcentral.com/1741-7015/9/31/.

【 授权许可】

CC BY   
© Lai et al; licensee BioMed Central Ltd. 2011