Nelson Systematic Reviews to Answer Healthcare, Questions, 2e

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Chapter 6 • Selecting Studies for Inclusion

Population Intervention and Comparator includes scheduling, reminders, and referral services, another study may include an inter vention with similar types of services but not use patient navigation terminology. Rather than exclude questionable studies, the reviewers considered how to refine their inclu sion criteria without compromising their ability to address the research questions of the systematic review (Table 6.3). They resolved these issues through team discussions and added their changes to the inclusion criteria in the revised protocol and methods section of the report. Navigation services were defined to include outreach activities involving letters or calls, educational materials and sessions, assessment and reduction of barriers to screening, language translation, appointment scheduling and reminders, bowel prep assistance for colorectal cancer screening, mailed supplies and kits, transportation and appointment attendance as needed, and point-of-care prompts, among others. TABLE 6.3 STUDY SELECTION ISSUES AND RESOLUTION OBSERVATION ISSUE IMPLICATION RESOLUTION Studies enrolled participants from multiple settings Participants may not represent populations adversely affected by dis parities as defined in the inclusion criteria Reduces clinical relevancy of the systematic review Only include studies with the majority of participants from populations adversely affected by health disparities Studies did not describe or differentiate characteristics of participants Participants from general or mixed populations (eg, low income, rural) may differ from those from specific groups (racial and ethnic minori ties) even when they all meet the definition of populations adversely affected by health disparities Potential confounding of results Include all eligible studies and consider subgroup analysis based on specific participant characteristics as available The interven tion services were often not identified as patient navi gation by the study Patient navigation ser vices are not consistently recognized as such Possible exclu sion of studies not explicitly providing patient navigation Include studies of inter ventions providing services broadly considered types of patient navigation regard less of whether the term is used Navigation services varied across studies Combining all types of services in the interven tion group assumes that they result in similar out comes Use a broad definition of patient navigation to include the wide range of services and consider subgroup analysis based on specific components or intensity Population The systematic review protocol specifies the populations of interest as clearly as possible. These generally include the condition or indication and demographic criteria (eg, age and sex). However, studies may enroll mixed or poorly defined populations, or populations that appear to meet the intent of the criteria, but not the prespecified specific criteria. For example, a trial may enroll participants diagnosed with a particular condition, but not use the diagnostic criteria spec ified in the inclusion criteria of the systematic review protocol. In this situation, the reviewers Cannot compare effectiveness and harms of specific compo nents of patient navigation services

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