Cochrane Skin is moving towards a model of supporting a smaller number of high priority systematic reviews, especially those where novel methodological approaches are required. Here we present our experience of supporting priority reviews in a new area of Diagnostic Test Accuracy (DTA) Reviews. Skin cancer is the commonest form of cancer, and early diagnosis leads to better outcomes. A number of diagnostic and staging tests are available, but their accuracy has not been systematically reviewed. Some overviews are also planned to inform policy, such as National Institute for Health and Care Excellence (NICE) Guidelines.
We supported a UK programme of systematic reviews on the diagnosis and staging of skin cancer as a priority during 2014 to 2018, working with the Biostatistics, Evidence Synthesis and Test Evaluation team in Birmingham. This were funded by the National Institute for Health Research (NIHR) and they were the first DTA reviews to be supported by Cochrane Skin.
Although the original timeline was three years, the submission of the draft reviews did not begin until mid-2017, and an extension was necessary. The challenges have included doing editorial checks when we have never dealt with DTA reviews before and there was little guidance about how to check them; finding clinical referees outside our usual contacts, with short deadlines and slipping timelines; having to submit the reviews to the DTA peer review and editorial process over which we had no control; keeping references to the other titles in the group consistent; and other details necessary in such a large and complex project where everything is linked together.
With appropriate editorial training and a funded, skilled review team, it is possible to address priority reviews using novel methodologies within a reasonable time frame. Delays in review production by the review team made it a challenge to give protected editorial support time to the reviews at different stages in order to meet external deadlines, and should be anticipated at review planning stage.
Patient or healthcare consumer involvement:
Two consumers were involved from the beginning of the project on the Advisory Group and as co-authors, making sure that the patient viewpoint was considered across the suite of reviews. Consumer referees were also used where time permitted.