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Lessons from a (not so) rapid review

RobertKerrison7 March 2019

Authors: Robert Kerrison, Christian von Wagner, Lesley McGregor

Introduction

Systematic reviews enable researchers to collect information from various studies, in order to create a consensus. One of the major limitations of systematic reviews, however, is that they generally take a long time to perform (~1-2 years; Higgins and Sally, 2011). Often, it is the case that an answer to a question is required quickly, or the resources for a full systematic review are not available. In such instances, researchers can perform what is known as a ‘rapid review’, which is a specific kind of review in which steps used in the systematic review process are simplified or omitted.

As of right now, there are no formal guidelines describing how to perform a rapid review. A number of methods have been suggested (Tricco et al., 2015), but none are recognised as being ‘best in practice’. In this blog, we describe our experience of conducting a rapid review, the obstacles encountered, and what we would do differently next time.

For context, our review was performed as part of a wider project funded by Yorkshire Cancer Research. The aim of the project was to develop and test interventions to promote flexible sigmoidoscopy (‘bowel scope’) screening use in Hull and East Riding. The review was intended to inform the development of the interventions by identifying possible reasons for low uptake.

Obstacles

Our first task was to select an approach from the plethora of options described in the extent literature. On the basis that many rapid reviews are criticised for not providing a rationale for terminating their search at a specific point (Featherstone et al., 2015), we opted to use a staged approach (previously described by Duffy and colleagues), which suggests researchers continue to expand their search until fewer than 1% of articles are eligible upon title and abstract review (the major assumption being that, if successive expansions yield diminishing numbers of potentially eligible publications, and the most recent expansion yields a relatively small addition to the pool, stopping the expansion at this point is unlikely to lead to a major loss of information).

After deciding an approach, our next task was to ‘iron out’ any kinks with the method selected. Several aspects of the review method were not fully detailed by Duffy and colleagues in their paper, and therefore needed to be addressed. Such aspects included: 1) how authors selected search terms for the initial search, 2) how authors selected the combination and order in which search terms were added to successive searches, 3) whether authors restricted search terms to titles and abstracts, 4) how many authors screened titles and abstracts and, 5) if two or more authors reviewed titles and abstracts, how disagreements between reviewers were resolved.

Through discussion, we agreed that: 1) the initial search should include key terms from the research question, 2) successive searches should include one additional term analogous to each of those included in the initial search (to ensure a large number of new papers was obtained), 3) the order and combination in which search terms should be added to successive searches should be based on the combination and order giving the greatest number of papers (i.e. to ensure that the search was not terminated prematurely), 4) search terms should be restricted to titles and abstracts, 5) titles and abstracts should be reviewed by at least two reviewers and, 6) disagreements between reviewers should be resolved through discussion between reviewers (see: Kerrison et al., 2019, for full details regarding the method used).

Experience

Having agreed an approach, and ironed out any issues with it, we were then faced with the task of performing the review itself. While this took less time to perform than a traditional systematic review, it was still a lengthy process (approx. 4 months). As per the systematic method, we were required to screen hundreds of titles and abstracts and extract data from many full-text articles. Perhaps the most time-consuming aspect of the entire review, was the process of manually entering the many different combinations of search terms to see which gave the largest number of papers for review at each stage. It is possible that, in the future, a computer programme could be developed to automate this process; however, this would only likely occur if the method was widely accepted by the research community.

After performing the review, we submitted the results for publication in peer-reviewed journals. Having never previously performed a rapid review, we were uncertain how it would be received. Disappointingly, our initial submission was rejected, but did receive some helpful comments from reviewers. While we were slightly discouraged, we decided to resubmit our article to Preventive Medicine, where it received positive reviews and, after major revisions, was accepted for publication.

Next time

So, what would we do differently next time? For a start, we’d consider using broader search terms. Our searches only detected 52% of papers prior to searching the reference lists of selected papers. We think that the main reason for this is that search terms were restricted to abstracts and titles, which often did not mention ‘flexible sigmoidoscopy’ (or variants thereof), specifically. Instead, most papers simply referred to the predictors of all colorectal cancer screening in the abstract (key words we had not included in our search terms in order to reduce the number of irrelevant papers reviewed), and then the predictors of each test in the main text. This problem is likely to repeat itself in other contexts (e.g. diagnostics and surveillance).

Another key change we would make would be to include qualitative studies and appropriate search terms to highlight these. Employing a mixed methods approach would help explain some of the associations observed, and thereby how best to develop interventions to address inequalities in uptake.

Final thoughts

Conducting a ‘rapid’ (4 months!) review has been an enjoyable experience. Like any research, it has, at times, been difficult. A lack of formal guidance, available for many forms of research today, made the process perhaps harder than it needed to be. With rapid reviews becoming increasingly common (read all about this here), it is our hope that this blog and paper will help make the process easier for others considering rapid reviews in the future.

Acknowledgements

This study was funded by Yorkshire Cancer Research (registered charity 516898; grant number: UCL407)

References

Duffy, S. W., et al. (2017). “Rapid review of evaluation of interventions to improve participation in cancer screening services.” Journal of medical screening 24(3): 127-145.

Featherstone RM, Dryden DM, Foisy M, et al. Advancing knowledge of rapid reviews: An analysis of results, conclusions and recommendations from published review articles examining rapid reviews. Systematic Reviews. 2015; 4(1): 50.

Higgins JP, Sally. G. Cochrane handbook for systematic reviews of interventions, version 5.1.0. . 2011.

Kerrison, R. S., von Wagner C, Green T, Winfield M, Macleod U, Hughes M, Rees C, Duffy S, McGregor L (2019) Rapid review of factors associated with flexible sigmoidoscopy screening use. Preventive Medicine.

Tricco AC, Antony J, Zarin W, Strifler L, Ghassemi M, Ivory J, Perrier L, Hutton B, Moher D, Straus SE (2015) A scoping review of rapid review methods. BMC medicine 13(1): 224

What goes up, must come down?

SamuelSmith8 September 2011

Plans to complete a Bowel Cancer Screening test reduce after exposure to the nitty gritty of the test

We all make plans to do things that are good for us, whether it is going for the Sunday morning jog, eating an extra spoonful of greens or saying no to that second (third or fourth!) drink in the pub. The problem is, when the time comes to actually doing whatever it is we’ve been promising ourselves and others to do, all those good intentions seem to disappear as quickly as they arrived.  For the runners among you that have woken only to be faced with a dark and drizzly January morning, you will know what it is that I’m talking about.

So why is it that some people are able to overcome hurdles like the miserable weather, the unappealing sight boiled cabbage and the luring temptation of that extra glass of bubbly? Here at the HBRC we are particularly interested in attempting to answer that question by researching how the perception of time influences people’s behaviour. Some people are always looking towards the future and always want to be prepared for what is to come. Others just want to live for the moment and prefer not to think about what could be round the corner. Interestingly, this appears to be a relatively stable personality characteristic and it is linked to how we feel about behaving in certain ways.

We have recently shown how plans to complete a bowel cancer screening test are affected by time perceptions. Completing a bowel cancer screening kit requires overcoming some pretty immediate obstacles (handling faeces being the most obvious to spring to mind). In addition, the benefits of doing the test won’t be experienced for at least one month (when you hopefully receive a reassuring all-clear letter), or worse, in several years’ time (when you have successfully lived for five years after your bowel cancer treatment). The question we wanted to answer was whether the same people that are able to get out of bed on a cold January morning ready for a 5 mile run, are better able to overcome the short term obstacles of a bowel cancer screening test. In other words, is the ability to look towards the future influencing decisions to complete a bowel cancer screening kit?

We presented some snippets of information to over 200 volunteer middle aged adults (i.e. the group approaching screening age) and asked them after each statement to report ‘how likely it is that you would take part in the screening programme’ (see box 1 for the statements we showed people). Our findings showed how certain parts of the screening programme (e.g. completing it at home) were appreciated, and after finding this out the volunteers increased the strength of their plans. However, once participants were gradually informed about the nitty gritty of the test, people started to waiver. Motivation rapidly declined once people realised they had to collect a sample of faeces and hit a second low when they were informed that the test requires this to be done three times.

Box 1 – Description of the test
1. The NHS has introduced a screening test for men and women of a similar age group
2. This test can detect colorectal cancer and pre-cancerous signs of colorectal cancer
3. This test is self-administered in your own home
4. This test provides a simple way for you to collect small samples of your bowel motions
5. This test involves you collecting your stools in a plastic tub and sampling them for tiny amounts of blood
6. This test involves smearing a sample of faeces onto the test kit using a cardboard stick
7. The test involves sampling three separate bowel movements within 14 days
8. Pictorial description of the test

 

 

 

 

 

 

Perhaps most interestingly is that people that prefer to live for the moment were more put off by completing it three times and by some photos explaining how to complete the test kit. This enables us to pinpoint the exact stage at which motivation is reduced the most, allowing us to intervene and help people overcome these obstacles.  While this is an exciting finding (even if we do say so ourselves!), it doesn’t explain why those who prefer to stay in the present reduce their motivation faster than others. Is it because they were more put off by the short term obstacles that might affect their short term plans? Or were they just less able to see how beneficial it might be for them in the future? Our analysis seems to suggest that as always, it might be a bit of both. So back to work it is for us, but not before that five mile run I told you about. Anyone?

Reference

Von Wagner, C., Good, A., Smith, S. G., Wardle, J. (in press) Responses to procedural information about colorectal screening using Faecal Occult Blood testing: the role of consideration of future consequences. Health Expectations. DOI: 10.1111/j.1369-7625.2011.00675.x

 

Sam (Samuel.smith@ucl.ac.uk)