To ensure the relevance and applicability of Cochrane reviews to the end-users, it is important that relevant and important questions be addressed. A number of Cochrane entities have planned and implemented independently different strategies to achieve this goal in the past, during which they encountered difficulties, barriers and challenges. Some of the priority questions required a substantial amount of time and resources that were not available for volunteer authors or else the Cochrane Review Group (CRG) was unable to find authors that were interested to undertake an important but controversial topic for a Cochrane review. In addition, prioritising which reviews to update is a current problem for CRGs.
The Cochrane Prioritisation Fund, 2006
In April 2006, within a joint meeting of Cochrane Centre Directors, Coordinating Editors and Steering Group members, the need for a more strategic approach to improve prioritisation mechanisms for key review topics was recognised to better meet the needs of national and international stakeholders, and to meet the Collaboration's own goals. In response, the Steering Group established the Cochrane Prioritization Fund in 2007 as a one-off initiative to fund projects mounted by Cochrane entities to address these aims.
Consequently, five prioritisation projects were identified and funded:
- Delivering on priorities: Developing and implementing effective collaboration between a Cochrane Review Group and a Cochrane Field (Led by Rajan Madhok and Helen Handoll, Cochrane Bone, Joint and Muscle Trauma Group).
- Using practice guidelines to determine review priorities: A pilot project (Led by Kay Dickerson, United States Cochrane Center).
- Prioritisation of Cochrane reviews: for consumers and the public in low- and high-income countries as a way of promoting evidence-based healthcare (Led by Janet Wale, Cochrane Consumer Network).
- Prioritising Cochrane review topics to reduce the know-do gap in low- and middle-income countries (LMIC) (A joint initiative of the Cochrane Health Equity Field, Cochrane Public Health Review group and the Cochrane Developing Countries Network).
- Piloting and evaluation of a patient-professional partnership approach to prioritising Cochrane reviews and other research (Led by Adrian Grant, Cochrane Incontinence Group).
Priority-setting workshop, 2008 Cochrane Colloquium, Germany
As part of the initiative on prioritizing Cochrane review topics to reduce the know-do gap in low middle income countries, a survey was conducted to review, evaluate and compare the current methods and processes of prioritisation across the Cochrane Collaboration.
The results of the survey revealed that most of the entities had a prioritisation process to identify new topics for Cochrane reviews. A wide variety of methods were used to identify topics and rank them, ranging from online surveys and web-based question submission options to face-to-face meetings with patients and clinicians. Two of the entities did not focus on prioritising topics for new reviews; one focused on prioritisation of already published Cochrane reviews to develop a dissemination strategy and the second one focused on prioritizing existing Cochrane reviews which needed updating. For most entities, the prioritisation projects did not define all of the potential topics for new reviews and volunteer authors could still propose additional topics. Similar to priority setting projects outside the Collaboration, some of the prioritisation projects also had other objectives e.g. planning dissemination and encouraging stakeholders to get involved in the work of the CRG. These results might have changed in the recent years owing to an increased interest in priority setting in the Cochrane Collaboration (more details will be published in the Journal of Clinical Epidemiology).
The results of this survey, along with other initiatives such as the Equity Evidence Aid, were presented and discussed in a Priority-setting workshop at the 2008 Cochrane Colloquium in Freiburg, Germany, and can be accessed at the link below:
2009 Cochrane Colloquium, Singapore
At the 2009 Colloquium in Singapore, a special session was held to examine the success of the prioritisation projects in the context of the strategic objectives of the Prioritisation Fund, and to explore the lessons to be learned for guiding future prioritisation efforts across the collaboration. These workshops were attended by members of different Cochrane entities including Review Group coordinators and coordinating editors, along with other external organisations like the James Lind Alliance, WHO and the Global evidence mapping project. The session included presentations by representatives from each of the prioritisation projects and was themed around the issues identified during the Strategic Planning session in 2006: Whose priorities should Cochrane reviews address? What are the risks and benefits of prioritisation? Should we be using a ‘top-down’ or ‘bottom-up’ approach to prioritising reviews?
At this second priority-setting related workshop, the success of prioritisation processes within the Cochrane Collaboration was evaluated by means of a conceptual framework and reported along with a case study on incorporating health equity and social determinants of health into the decision-making process, conducted in collaboration with the Cochrane Musculoskeletal group. The minutes of the workshop can be accessed at the link below:
Proposal and Establishment of the Cochrane Agenda and Priority Setting Methods Group
To ensure the sustainability of these priority-setting activities and to provide support and service to Cochrane entities, a Cochrane Agenda and Priority Setting Methods Group was proposed with the following aims in mind:
- To develop the necessary methodological guidance to ensure that the Cochrane review groups can choose and use appropriate methods and processes to identify priority topics for conducting or updating Cochrane reviews.
- To develop appropriate strategies for collaboration within the Cochrane Collaboration and between the Cochrane Collaboration and external organisations like the James Lind Alliance on identifying priority topics for Cochrane reviews. Prioritisation is also a key interest to other bodies, such as health technology assessment (HTA) agencies.
The proposal of an Agenda and Priority Setting Methods Group was presented and discussed in the meeting of the Cochrane Methods Group in Birmingham on 6-7 August 2009.
There were several challenges identified during these conceptual meetings:
Methodological and process issues:
- Dealing with health inequalities in developing and conducting priority setting.
- Challenges while involving multiple stakeholders in the process of prioritisation.
- Identifying appropriate criteria for conducting a priority setting strategy.
- Difficulties in evaluating, implementing/disseminating prioritisation processes.
- Methods to prioritise updating of Cochrane reviews.
- Uncertainties about which stakeholder groups are to be consulted in the prioritisation process (patients, clinicians, policy makers, funders) and at what steps they should be consulted.
- Identifying feasible interventions that Cochrane review groups can use to identify and prioritise relevant and important topics for Cochrane reviews.
- Identifying author groups, resources, and funding for prioritised topics.
- Difficulties that the Cochrane Review Groups have in balancing between conducting high-priority reviews and capacity building. An easy and less controversial topic would be more appropriate for a new author team than a complex but more important topic.
- Balancing author interests and preferences for review titles, and priorities identified using other criteria.
- Balancing between priority setting of new topics for Cochrane reviews and existing Cochrane reviews that need updating.
- Collaboration with other organizations that produce systematic reviews in priority setting to avoid duplication of efforts.
The above identified challenges in the methods/process of research priority setting and in their implementation demonstrate the need and importance of a new methods group to address these challenges, to support the Cochrane entities to improve their methods for priority setting and to enable them to better their selection of methods and processes for identification of priority topics for new Cochrane reviews or review updates.