Investigating human influences in systematic reviews and meta-analyses to improve the reliability and validity of evidence syntheses

每年有数十亿英镑用于医疗保健治疗，目的是改善和挽救生命。但并不是所有的临床研究都发表了，发表的内容并不可靠。通过汇集类似的研究，评估其质量和综合效应，可以使用更可靠的发现来指导未来的临床和政策决策。这种回顾研究方法的黄金标准被称为系统综述。这些大型报告以清晰和公平的方式总结了所有相关研究，以了解新治疗方法的优点和缺点。它们是高引用的文章，被认为是客观和透明的研究设计，是必要的，以告知病人护理。有越来越多的报告说，系统评价正在发表，不辜负他们的高质量声誉。系统性评价因其造成研究浪费、质量差异大、误导和服务于利益冲突而受到关注。当出版期刊要求作者申报利益冲突时，他们涉及到过去几年从工业界获得资金的狭窄标准。虽然系统性综述的最佳实践有明确的指南可供作者使用，但这些指南并不为审评小组本身提供指导。审查有时由对结果感兴趣的人进行（偏见）。或者，审查小组可能没有采取所有必要的努力来寻找和呈现决策者理解所需的证据的全貌（被动）。审查小组的成员可能对治疗有自己的看法，这可能会影响审查的方式。审评组可能没有足够的技能或资源进行高质量的审评（资源不足）。不灵活的审查方法可能导致昂贵的审查项目，而这些项目并不能反映对患者重要的问题。此外，有时评论是在没有资金的情况下发表的，作者的动机也没有受到质疑。当研究复杂的医疗保健问题时，人为因素对系统评价的影响可能尤为重要，考虑到系统评价作为公正和客观过程的声誉，不良行为可能比临床研究更有问题。卫生保健证据可能没有得到公平的评估，患者可能会因为卫生服务可能无法提供最好的治疗而受苦。研究方法：为了充分探索团队中的研究人员可以影响系统评价的方式，我计划：1）搜索和审查记录由于团队影响而可能发生的系统评价问题的研究。2)与研究方法方面的专家合作，为系统评价团队强调风险和解决方案，帮助确保我的研究结果对未来进行的系统评价产生影响。4)建立一个专门的网站和指南，以清晰和可访问的格式介绍系统评价中人为影响的风险，以帮助人们自己评估系统评价。5）与研究人员一起对指南进行测试，以改进和修订，确保它们对进行或使用系统评价的人有用。这项研究将描述什么是一个合适的团队，什么类型的团队影响力会导致系统评价的问题。该框架和指南将帮助从事或支付涉及系统性综述的研究的人了解他们在规划、资助或进行系统性综述时需要考虑的因素。为了影响更广泛的研究议程，将建立一个用户友好的网站，解释研究的目标、方法和结果。这项研究将导致更好的系统评价，为患者和公众的卫生服务提供卫生保健决策信息，并影响未来的卫生研究。

Billions of pounds are spent each year on health care treatments with the aim of improving and saving lives. But not all clinical research is published and what is published not be reliable. By bringing together similar studies, assessing their quality, and combined effects, more reliable findings can be used to guide future clinical and policy decisions. The gold standard of this method of reviewing studies is called systematic review. These large reports summarise all relevant studies in a clear and fair way to understand the benefits and drawbacks of new treatments. They are highly cited articles and regarded as objective and transparent research designs that are necessary to inform patient care.There are increasing reports that systematic reviews are being published that do not live up to their high quality reputation. Systematic reviews are receiving attention for contributing to research waste, varying massively in their quality, being misleading and serving conflicted interests. When authors are asked by publishing journals to declare conflicts of interest, they relate to narrow criteria about funds received from industry within the last few years. Whilst clear guidelines for best practice in systematic reviews are available for authors, they do not provide guidance on review teams themselves. Reviews are sometimes carried out by people who have an interest in what the results are (bias). Or review teams might not take all the necessary efforts to find and present a full picture of the evidence needed for decision makers to understand (passivity). Members of the review team might have their own view on a treatment and this might shape the way the review is done. Review teams may not be sufficiently skilled or have the resources to carry out a high quality review (insufficient resources). Inflexible review methods may result in expensive review projects which do not reflect issues that matter to patients. Also, sometimes reviews are published without funding and authors' motivation for this is not questioned. The effects that human influence has on systematic reviews may be especially important when looking at health care problems that are complex.Considering the reputation of systematic reviews as fair and objective processes, poor conduct could be more problematic than in clinical research. Health care evidence might not be evaluated fairly and patients may suffer because the health service may not provide the best treatments as a result. Methods: To fully explore the ways in which the researchers in the team can influence systematic reviews I plan to: 1) Search for and review studies documenting problems with systematic reviews that can occur due to team influence. 2) Work with experts in research methods to highlight risks and solutions for systematic review teams, helping to ensure that the findings of my research impact on systematic reviews that are carried out in the future. 4) Produce a dedicated website and guidance in a clear and accessible format about the risks of human influence in systematic reviews to help people assess systematic reviews for themselves.5) Test guidance with researchers to refine and revise, ensuring that they are useful to people who do or use systematic reviews.What impact will this research have? This research will describe what makes an appropriate team and what types of team influence can cause problems to systematic reviews. The framework and guidance will help people who do or pay for research that involves a systematic review to understand what factors they need to consider when planning, funding or doing a systematic review. To influence the wider research agenda a user-friendly website that explains the goals, methods and results of the research will be created. This research will lead to better systematic reviews, to inform health care decision making for health services for patients and the public and to influence future health research.