Review and Assessment of Network Meta-analyses for Knowledge Uptake Study

Study Overview
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Brief Summary
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This randomized controlled trial will assess the interpretability of the rank-heat plot for presenting the results of network meta-analysis in comparison to SUCRA (surface under the cumulative ranking) plots which are suggested to present one of the best ranking statistics.

Detailed Description
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Clinicians are responsible for making decisions to improve health outcomes. When available, clinicians should use the results of a knowledge synthesis, such as systematic reviews and meta-analyses, to inform decision-making. Pairwise meta-analyses are limited, however, by the availability of RCTs that directly compare interventions. This is troublesome for knowledge users who require results from comparisons of multiple interventions to inform decision-making. To address this concern, the use of network meta-analyses (NMAs) is increasing in healthcare the literature. NMAs are a useful tool because they can summarize results from numerous studies and interventions. It is unclear how NMA results should be presented to increase the likelihood of clinicians understanding and using the results to improve health outcomes. Thus, a randomized controlled trial of NMA plots will be conducted. Participants will be randomized to either the rank-heat plot (intervention) or SUCRA plots (control) that present the same NMA results of a study that explored the effectiveness of quality improvement interventions for falls prevention. Outcomes will be ascertained via an online survey. The RCT will take place in an online environment and will require each participant to partake in a single session. This study will help guide best practices for the presentation of reviews to improve the uptake and use of NMA.

Official Title
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Review and Assessment of Network Meta-analyses for Knowledge Uptake (RANK) Study

Conditions
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Clinical Decision-making

Intervention / Treatment
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* Other: Rank-Heat Plot
* Other: SUCRA Plot


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinicians must be accredited to practice in Canada and working (full- or part-time) as a family physician or general internist. Exclusion Criteria: Unable to read and understand English; No access to the internet; Read, co-authored or peer-reviewed the study: Quality Improvement strategies to Prevent Falls in the Elderly: A systematic review and network meta-analysis (manuscript in preparation).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: 2-arm, parallel assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rank-Heat Plot<br>The intervention group will receive an online survey to evaluate their interpretation of the results from the NMA with a rank-heat plot including results from 2 outcomes that were selected by our knowledge users (#injurious falls, #fractures). | Other: Rank-Heat Plot<br>* provides a visual presentation of treatment hierarchy across multiple outcomes<br>|
| Active Comparator: SUCRA (surface under the cumulative ranking) Plot<br>The control group will receive an online survey to evaluate their interpretation of the results from the NMA with the SUCRA plots including results from the same 2 outcomes that will be presented to the intervention group (i.e., #injurious falls, #fractures). | Other: SUCRA Plot<br>* provides a visual presentation of treatment ranking for a single outcome.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of participants who appropriately define the clinical bottom line. Participants' answers will be independently evaluated by two investigators for agreement with an expert panel's recommendation. |  | during experiment via single session, <1 hour survey | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of participants who accurately apply the evidence to the provided clinical scenario. |  | during experiment via single session, <1 hour survey | 
| Completeness of survey data evaluated by two independent investigators |  | Immediate post-experiment | 
| Time taken to complete survey |  | Immediate post-experiment |