How effective are Cochrane Clinical Answers at providing a clear response to the clinical questions posed?

Session: 

Oral session: Knowledge translation and communicating evidence (2)

Date: 

Sunday 16 September 2018 - 14:50 to 15:00

Location: 

Pentland Auditorium

All authors in correct order:

Pettersen K1
1 Wiley, UK
Presenting author and contact person

Presenting author:

Karen Pettersen

Contact person:

Karen Pettersen
Abstract text
Background:To assist their users in making informed decisions about what treatments to use, BMJ Clinical Evidence devised a categorisation system, which aimed to identify treatments that work (benefits outweigh the harms) and highlight treatments that do not work (harms outweigh benefits). However, in 2017, the ‘state of the evidence’ for the around 3000 treatments assessed by Clinical Evidence using randomized controlled trial (RCT) evidence suggested that around 50% of treatments were categorized as ‘Unknown effectiveness’ for specific indications. Cochrane Clinical Answers (CCAs) also aims to inform decision making by making Cochrane Review evidence more accessible and actionable and faces similar challenges regarding uncertainty.

Objectives: To assess the ‘state of evidence’ in 2018 for treatments assessed in 1200 CCAs, using a similar categorisation to that devised by BMJ Clinical Evidence and highlighting the proportion of CCAs affected by insufficient RCT data.

Methods:An assessment of 1200 CCAs covering a wide range of clinical disciplines, including Cardiology, Emergency Care, and Pregnancy & Childbirth was performed. Each Answer was categorised as to the nature of the clinical guidance it provided.

Results: Assessment of 1200 CCAs suggests some parity with the results of the BMJ Clinical Evidence, with 18% of CCAs suggesting that there was at least moderate-quality evidence of benefit, 34% suggesting that there was lower-quality evidence of benefit or some caveats regarding benefit (as to how/when to use, need to balance benefits and harms), 10% suggesting that there was evidence of overall net harm or a superior alternative, and 38% treatment effectiveness unknown. The analyses in 2016 and 2017 found similar percentages across categories.

Conclusions: CCAs make it easier for healthcare professionals to apply high-quality Cochrane Review evidence when managing patients. However, analyses over the past three years show that there are many questions for which we do not have a clear answer where the main strength CCAs is to quickly highlight that clinicians need to apply expert judgement and non-randomized evidence.

Patient or healthcare consumer involvement: CCAs are written by clinician authors who assess the degree to which there is certainty regarding the answer to the question posed.

Relevance to patients and consumers: 

It is important that clinicians have certainty when making clinical decisions. There continues to be a number of clinical questions for which randomized controlled data cannot provide answers. This presentation assesses the degree of uncertainty across Cochrane Clinical Answers and the reasons for this uncertainty.