Title: Development and Evaluation of Synthesis Methods for Living Systematic Reviews including an Interactive Platform for Analysis, Updating and Dissemination: An Application to Electronic Cigarettes for Smoking Cessation
Funder: Department of Health and Social Care

Abstract: BackgroundSystematic reviews (SR) are well-established methods for appraising and synthesising all the relevant evidence to answer a specific research question(s) and form a key component of healthcare decision-making. In SRs, the available evidence is identified by systematically searching the literature and, where appropriate, using meta-analysis to combine individual study results. Such reviews provide a snapshot of the research evidence at a particular point in time and can become out-of-date quickly after publication. To ensure clinical decisions and guidelines are based on the most up-to-date evidence, it is important that reviews are updated regularly, but achieving this can be very resource-intensive and reviews still remain out-of-date between updates.'Living systematic review' (LSR) is a new approach that continuously checks for and incorporates new evidence as it becomes available. This approach enables review results to be kept up to date in real-time and is particularly pertinent when answering high priority/highly research-active health questions where emerging evidence is likely to have an immediate impact on decision-making; e.g. treatments for COVID-19. Whilst the approach shows great potential, further methodological work is needed on the conduct and communication of continually updated results from LSRs to ensure benefits are maximised to inform clinical practice, decision-making, and future study design.AimsThis fellowship aims to: i) improve evidence synthesis methods used for LSRs; and ii) provide a dynamic interactive platform to aid implementation of (network) meta-analyses embedded within LSRs with respect to analysis, updating and dissemination. Plan of investigationThe fellowship will consist of four work packages:WP1: Review LSRs commenced to date with respect to: a) Evidence synthesis methodology applied; and b) Methods used to report and communicate the evolving evidence-base and updated analysis results over time. WP2: Adapt methods for updating traditional SRs to identify optimal time points at which to publish continually updated LSR results. Explore how meta-analysis results from LSRs may be used to inform the design of future research. Methods will be applied to an electronic cigarettes LSR case study.WP3: Develop a web-based dynamic user-friendly interactive platform for the e-cigarette LSR example with accessible visual displays to aid understanding of the clinical/policy/research implications for distinct stakeholder groups. WP4: Assess generalisability of the platform and demonstrate how the platform can be integrated into emerging digital reporting formats to overcome the practical challenges of publishing continually updated LSRs and associated living guidelines to ensure timely dissemination. Anticipated ImpactThe methods developed as part of this project will ensure guidelines and clinical decision-making are based on the most up-to-date evidence. Evidence-based decision-making informs the types of interventions that are made available in the NHS and influences the care that is delivered by health professionals, often resulting in cost savings. The platform and data visualisation approaches will be made freely available to facilitate uptake. This will lead to timelier updating of LSRs, improved targeted communication of their findings, more effective clinical decision-making and, ultimately, improved patient health outcomes.

Lay abstract: BackgroundEvery year, a huge amount of health-related research is published and it is difficult for busy doctors and healthcare workers to keep up to date with all of the new evidence. To help with this, the research can be summarised by carrying out a review. This is known as a 'systematic review' if it is carefully carried out by two or more researchers. We use systematic reviews to get an accurate and fair summary of all the research available. This may involve combining information from different studies to see how well a particular treatment works, or comparing different treatments to see if one treatment works better than another. These results help us to decide which treatments should be used in the NHS. Usually, these reviews provide information on the current research evidence available. For this reason, they can quickly become out-of-date.There is a new and exciting type of review called a 'living systematic review' which is continually updated with new research evidence as it becomes available. This type of review is hugely important for 'high priority' health questions that need to be put into practice straight away, such as new treatments for COVID-19. However, there needs to be more work done on deciding when and how these reviews should be updated, and how best to summarise the findings in a way that is reliable and easily understandable to everyone involved, including patients.Aims and methodsFor this project, I want to develop new statistical approaches for analysing studies in a living systematic review. We need these new approaches because results in a living systematic review are continuously being updated so the findings and recommendations might change. We may also be aware of studies that have not yet been published which need to be considered when making recommendations about further research that needs to be carried out.As well as these new approaches, I also plan to create a user-friendly computer-based tool to help people carry out living systematic reviews. This tool will make it easier to analyse and publish regular updates and will also present results using the best methods available in a visual format to make it easy to understand for everyone who is interested, including doctors, patients and people who make policy decisions.I will create the tool by focusing on an existing living systematic review which looks at the use of electronic cigarettes (e-cigarettes) to help people to stop smoking. I will then adapt my work by looking at other systematic reviews before finalising my tool.Patient and Public InvolvementThose working on the e-cigarettes review have spoken to people who smoke, have smoked or have switched from smoking to e-cigarettes for their review. As I will be using this review for my work, I will also be able to communicate with them and they will help me throughout my project to make sure the project stays relevant to patients and the public.Dissemination and ImpactThe methods that I develop, including the user-friendly tool and new visual displays, will help make sure that treatment decisions are made using the most reliable and up-to-date evidence. They will provide doctors with better information about how best to treat people, which will help to improve health outcomes. Researchers will also have better information about what future research should be done.Finally, all of my methods and tools will be made available to researchers doing living systematic reviews in the future. Therefore, all living systematic reviews can benefit from my research which will improve their quality and, ultimately, improve healthcare for all.

Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL;STROKE