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 370 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.
Current priority setting work
Cochrane Airways Priority-Setting Advisory Group
We ran a survey for members of the public including patients, carers, healthcare professionals and researchers. We asked for their questions about living with a chronic lung disease. The survey was called ‘Your Lungs, Your questions’ and had the hashtag #AskCochraneAirways. We got over 150 responses, mainly from patients. We found that there were 99 unique questions.
We have formed a priority-setting advisory group to help us make sense of these uncertainties. The advisory group includes patients, carers, health care professionals, researchers and people from lung charities. They have approved the list of uncertainties to be prioritised and are now working on ranking them. We hope to have a priority list to share in January 2020. We will then being working on priorities that arise through literature surveillance, the updating classification project, and submitted by guideline producers or other stakeholders. For further information see our plan.
COPD patient group - NIHR programme grant - ongoing
We formed a Patient Advisory Group including people living with COPD being treated at St George’s Hospital, London. They told us that air pollution, living with multiple illnesses, remembering to take their medication and attending organised exercise classes (called pulmonary rehabilitation) was really important to them. We used these priorities to shape the programme grant application, which was successful. We meet twice a year with the patients and so far they have been hugely helpful in developing the protocols for the reviews. We are currently working with them to complete these reviews and disseminate them.
Updating classification project
See here for further details
Older priority setting work
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.