Conclusiveness of Cochrane Reviews on Nursing Interventions for Patients with Cancer: A Systematic Analysis.

Background: This study aimed to assess the conclusiveness of Cochrane Reviews (CRs) in oncology nursing. Methods: We searched systematically for all CRs published in the Cochrane Library in the oncology nursing field between January 2014 and April 2023. We analyzed the difference between conclusive and inconclusive outcomes using the χ2 and Mann-Whitney U-tests and identified 430 articles. However, we excluded 385 articles after reviewing their titles and abstracts. We assessed 45 full-text articles for eligibility and identified 32 articles. Of the 32 articles, we extracted 19 interventions. Results: The overall outcomes were 182 cases, with 51.6% (n = 94) and 48.4% (n = 88) demonstrating conclusiveness and inconclusiveness, respectively. Regarding conclusiveness, 28.0% (n = 51) and 23.6% (n = 43) reported that the studied interventions were effective and ineffective, respectively. We found that studies on interventions related to physical activity and yoga had significantly high rates of conclusive. Compared with inconclusiveness outcomes, conclusive outcomes involved significantly more studies (p < 0.001) and patients (p < 0.001). Conclusions: Ultimately, these findings reveal that in the oncology nursing field, only 51% of the main outcomes of each nursing intervention in CRs were conclusive.

Conclusiveness of the Cochrane Reviews in Family Nursing: A Meta-research Study.

This study established the clinical conclusiveness of Cochrane reviews (CRs) in family nursing. We extracted relevant characteristics of CRs to determine the methods of obtaining high-level evidence for family nursing. We performed a systematic search of all CRs on family nursing published in the Cochrane Library between January 2014 and April 2023. After screening 1212 titles and abstracts, we identified seven potentially relevant articles. Upon reviewing their full texts, we included six CRs with a total of 34 interventions. Of these, 22 (64.7%) interventions were conclusive and 12 (55%) were inconclusive. Thus, the number and percentage of conclusive CRs is lower in family nursing versus other fields.

Conclusiveness, linguistic characteristics and readability of Cochrane plain language summaries of intervention reviews: a cross-sectional study.

BACKGROUND: One of the most important formats to disseminate the evidence in health to different populations are Cochrane Plain Language Summaries (PLSs). PLSs should be written in a simplified language, easily understandable and providing clear message for the consumer. The aim of this study was to examine the extent to which PLSs are customized for lay persons, specifically by providing conclusive, comprehensible, and readable messages. METHODS: The study analyzed Cochrane PLSs of interventional studies (N = 4360) in the English language published from 1995 to 2019. We categorized the conclusiveness into one of the following categories: "positive", "positive inconclusive", "no evidence", "no opinion", "negative", "negative inconclusive", "unclear", "equal", "equal inconclusive". Language characteristics were analyzed using Linguistic Inquiry and Word Count (LIWC) software. The level of readability was measured by SMOG (Simple Measure of Gobbledygook) index, indicating the number of years of education required to read the text. For each PLS, we also collected the following data: Cochrane Review Network, year of publication and number of authors. RESULTS: Most of the PLSs (80%) did not have a conclusive message. In 53% PLSs there was no concluding opinion about the studied intervention or the conclusion was unclear. The most frequent conclusiveness category was "no opinion" (30%), and its frequency increased over time. The conclusiveness categories were similarly dispersed across Cochrane Networks. PLSs were written in an objective style, with high levels of analytical tone and clout above neutral, but a lower relation to authenticity and tone. The median number of years of non-specific education needed to read the PLSs was 14.9 (IQR 13.8 to 16.1), indicating that the person needs almost 15 years of general education to read the content with ease. CONCLUSION: Most of the Cochrane PLSs provided no concluding opinion or unclear conclusion regarding the effects of analyzed intervention. Analysis of readability indicated that they may be difficult to read for the lay population without medical education. Our results indicate that PLSs may not be so plain, and that the writing of Cochrane PLSs requires more effort. Tools used in this study could improve PLSs and make them better suited for lay audiences.

When is the evidence conclusive? Analysis of systematic reviews for which Cochrane declared that conclusions will not change with further studies.

Some Cochrane reviews were declared stable or closed, that is, not in need of updating. For some of them, it has been declared that conclusions will not (or it is unlikely they will) change with further studies. We explored whether there is a discernable decision-making pattern for decisions about the conclusiveness and stabilization of these reviews. We analyzed Cochrane reviews published until April 2020 labeled as stable or closed. We extracted the rationale leading to the decision declaring that the conclusion is not expected to change with further studies. Furthermore, we assessed whether the reviews used GRADE analysis. We extracted data from summary of findings (SoF) tables on the direction of effect, statistical significance, and I2 values for the first and primary outcomes in SoFs, conclusions in the abstract and review, and implications for practice and future research. We included 40 stable/closed Cochrane reviews. Rationales for their stabilization did not enable any insight into the Cochrane's decision-making algorithm for considering the evidence as conclusive. Among 191 outcomes presented in the SoFs, 70% were rated with either low or very low certainty evidence. None of the reviews mentioned in the text that the review should be stabilized or closed, or that there is sufficient evidence on the subject. Reasons for stabilizing/closing Cochrane reviews were unclear, and we could not discern any pattern of "conclusive review" traits. Definition of systematic review conclusiveness is still lacking, which may contribute to research waste.

Reasons and factors associated with inconclusiveness of systematic reviews about interventions for neuropathic pain.

Aim: Systematic reviews (SRs) are frequently inconclusive. The aim of this study was to analyze factors associated with conclusiveness of SRs about efficacy and safety of interventions for neuropathic pain (NeuP). Materials & methods: The study protocol was registered in the PROSPERO database (No. CRD42015025831). Five electronic databases (Medical Literature Analysis and Retrieval System Online, Cochrane Database of Systematic Reviews, Cumulative Index for Nursing and Allied Health Literature, Database of Abstracts of Reviews of Effects and Psychological Information Database) were searched until July 2018 for SRs about NeuP management. Conclusion statements for efficacy and safety, and characteristics of SRs were analyzed. Conclusiveness was defined as explicit statement by the SR authors that one intervention is better/similar to the other in terms of efficacy and safety. Methodological quality of SRs was assessed with the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) tool. Results: Of 160 SRs, 37 (23%) were conclusive for efficacy and/or safety. In the SRs, conclusions about safety were missing in half of the analyzed abstracts, and a third of the full texts. Conclusive SRs included significantly more trials and participants, searched more databases, had more authors, conducted meta-analysis, analyzed quality of evidence, and had lower methodological quality than inconclusive SRs. The most common reasons for the lack of conclusiveness indicated by the SR authors were the small number of participants and trials, and the high heterogeneity of included studies. Conclusion: Most SRs about NeuP treatment were inconclusive. Sources of inconclusiveness of NeuP reviews need to be further studied, and SR authors need to provide conclusions about both safety and efficacy of interventions.

How to decide whether a systematic review is stable and not in need of updating: Analysis of Cochrane reviews.

BACKGROUND: It is challenging to keep systematic reviews (SR) current and updated. Cochrane designated some of its SRs as "stable," that is, not in need of updating. The issue of stabilizing an SR is an important in research synthesis, because it could help reduce research waste. The aim of this study was to analyze publicly available justifications for stabilizing a Cochrane review, with the ultimate goal of helping to make decisions about whether the update of any SR is warranted. METHODS: We analyzed Cochrane reviews labeled as stable in Archie, Cochrane's system for managing the editorial/publishing process. From the "What's new" section of the reviews in the Cochrane Library, we extracted justification for stabilization. RESULTS: We included 545 Cochrane reviews labeled in Archie as stable on October 28, 2019. The most common of the five reasons for stabilization was that "last search did not identify any potentially relevant studies likely to change conclusions" (N = 99; 18%), followed by "research area no longer active" (N = 86; 16%), "review is or will be superseded" (N = 41; 7.5%), "evidence is conclusive" (N=35; 6.4%), and "intervention no longer in general use" (N = 34; 6.2%). For the 269 (49%) Cochrane reviews, we considered that the justification for stabilization was not clearly described, that is, sufficiently informative. CONCLUSIONS: Cochrane reviews would benefit from more transparency and consistency in publicly available justifications for stabilizing reviews. Further work in this field will help make decisions about the futility of further research and deciding on enough evidence in the field of research synthesis.

Conclusiveness of the Cochrane Reviews in Palliative and Supportive Care for Cancer.

To assess the conclusiveness of the Cochrane reviews (CRs) in the field of palliative and supportive care for cancer. We searched the CRs on Pain, Palliative, and Supportive Care Group available in the Cochrane library on February 01, 2015, to analyze whether a CR could reach a clinical decision. Each CR was analyzed for conclusiveness, number of randomized controlled trials (RCTs) enrolled, number of participants enrolled, the need for further studies, and the reasons. Only 45% (30 of 66) of the CRs reached definitive clinical recommendations. The number of RCTs and participants enrolled in conclusive CRs were significantly higher than those in inconclusive CRs. Nearly all CRs recognized the need for further studies. The conclusiveness was not affected by the year of publication. We concluded that a large number of clinical trials were not carried out well in the palliative and supportive oncology.

Conclusiveness resolves the conflict between quality of evidence and imprecision in GRADE.

OBJECTIVES: The objective of our article is to show how "quality of evidence" and "imprecision," as they are defined in Grading of Recommendations Assessment, Development, and Evaluation (GRADE) articles, may lead to confusion. We focus only on the context of systematic reviews. STUDY DESIGN AND SETTING: We analyze, with the aid of standard probabilistic and statistical concepts, the concepts of quality of evidence and imprecision as used in the GRADE framework. This enables us to point out some weaknesses in the relation between "quality of evidence" and "imprecision." RESULTS: The GRADE framework contains terms familiar from classical statistics, but these terms are used in nonstandard ways. Notably, "imprecision" does not have the meaning in the GRADE framework that it has in statistics, and the well-known table of "evidence levels" wrongly suggests that "quality of evidence" and "accuracy" express the same concept-they do not. CONCLUSION: We believe that "conclusiveness" rather than "imprecision" would be a suitable term to use when the question whether the CI excludes or includes certain critical margins is being addressed. Conclusiveness could also replace quality of evidence as the final step for a systematic reviewer.