Systematic Reviews to Answer Health Care Questions

Sources: Data from Nelson HD, Cantor A, Wagner J, et al. Achieving health equity in preventive services: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med . 2020;172:258–271. Nelson HD, Cantor A, Wagner J, et al. Effectiveness of patient navigation to increase cancer screening in populations adversely affected by health disparities: a meta-analysis. J Gen Intern Med . 2020;35(10):3026–3035.

STRENGTH OF

EVIDENCE

TABLE 12.4 STRENGTH OF EVIDENCE GRADES FOR STUDIES OF PATIENT NAVIGATION TYPE OF SCREENING Breast cancer 10 RCTs (8,414); 1 before-after study (91); 1 post- intervention time series (1,664) Medium Consistent Direct Precise Undetected Moderate Cervical cancer 3 RCTs (2,378); 1 nonrandomized trial (1,763) Medium Consistent Direct Precise Undetected Moderate Lung cancer 1 RCT (1,200) High None Direct Imprecise Undetected Low Abbreviation: RCT, randomized controlled trial. NUMBER OF STUDIES; STUDY DESIGN; PARTICIPANTS ( N ) STUDY LIMITATIONS CONSISTENCY DIRECTNESS PRECISION REPORTING BIAS Colorectal cancer 22 RCTs (17,632); 3 nonrandomized trials (1,392); 2 before-after studies (4,882) Medium Consistent Direct Precise Undetected High

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