Prioritising our work

What is prioritisation?

Prioritisation is making an informed decision about what work you will do, given that you have limited time and resources compared to the amount of work that could potentially be done.

Why is this an issue for Cochrane Airways?

We have over 290 published Cochrane Reviews to update and around 40 new reviews in progress at any one time, which is a lot of work for editorial and author teams. We need to make the most of our publically funded resources, by focussing on the most important reviews to people making decisions about their healthcare.

What are the benefits of prioritisation?

Even updating a review with no studies requires a certain amount of effort. This is because there are new expectations for Cochrane Reviews emerging all the time, for instance new methodology and standards in plain English. It can be important to update reviews even if there are no studies because people are frequently using them. On the other hand, we must have reviews of new treatments and update the reviews where the biggest controversies exist, so it is a balancing act.

What reasons might there be for prioritising a review?

Reasons for updating reviews or writing new reviews are:

  • major new trial published which will change conclusions of review
  • interventions major cost to health service
  • intervention is important in LMIC settings
  • intervention is important to patients
  • there is considerable uncertainty in review or in the clinical question in general
  • review is highly accessed or cited and the methods need updating

A lot of this is already considered by review teams because our authors work in a similar funding environment and are often applying evidence from systematic reviews in their daily practice! We are not overwhelmed by requests to update reviews which are no longer of clinical interest. The prioritisation work has come out of a need to be transparent about what we do and to gain more control over the reviews in our scope so the reviews are as helpful as they can be for people making decisions about healthcare.

What are the downsides?

There is some risk of upsetting review teams over turning down requests to update their review, or handing over the review to be updated by a new review team. However, Cochrane Reviews belong to the public and not to the review author team. Hopefully the original author team will want to and be able to update the priority review, but if not, they need to hand it over to another review team.

Cochrane Airways now tends to register fewer review titles with a higher threshold for what is acceptable and we only update priority reviews which were identified or reviews for which the author team can make a convincing case for the need to prioritise. This may mean a lower review output, but with higher quality and relevance.

We need to be mindful of smaller disease areas where there is less research focus and which have less impact in a health system, but large impact for people living with those diseases.

What has Cochrane Airways done so far in terms of prioritisation?

In the past four years, we have devoted a significant amount of effort to this end in formal projects.

Prioritisation project 2012
We undertook a pragmatic prioritisation process in 2012. Our approach involved four different strands: 1) understanding patient uncertainties about asthma; 2) piloting a prioritisation tool to assess whether individual reviews require updating; 3) surveying the CAG Editorial Board; and 4) horizon scanning for new review titles. Full details of our work can be found in our open access publication in the Journal of Clinical Epidemiology

Asthma workshop October 2014
We held an asthma workshop with 15 people affected by asthma and 5 healthcare professionals. A full report of the day is available here.  The purpose of the workshop was to identify 10 review titles to be complete for our asthma programme grant (NIHR 13/89/14) which can be found here together with information about what was said and some further information. What was great about this day was hearing people’s issues about living with asthma. Asthma is a long term condition which people have to find a way to cope with and they want a normal life– to be able to plan a trip away, to get to school and pass their exams, not to be stuck in on the couch anxious about triggers.

Organising a face-to-face workshop is enjoyable and worthwhile, but it is time-consuming and costly. Here is a link to some details about the practicalities for other groups who might consider doing same.

What are the future plans for the CAG?

There are around 10 priority review updates in progress. We have also accepted a number of other requests to update reviews where we believe there will be a change in the conclusions (treatment effect or strength of conclusions). We will begin work on nine priority updates which were identified as a result of the asthma workshop in the programme grant lead by Kayleigh Kew here at the editorial base. Editors from our Australian Satellite initiated a prioritisation exercise on physiotherpay-related reviews across our clinical scope.