Why are Cochrane hepato-biliary reviews undervalued by physicians as an aid for clinical decision-making?
Received 11 June 2009; accepted 2 July 2009. published online 10 August 2009.
Abstract
Background
Cochrane systematic reviews are of higher quality than reviews published in scientific journals, yet are used less than other sources for clinical decision-making.
Aim
To assess whether the characteristics of the Cochrane systematic reviews can account for their scant use by physicians.
Materials and methods
We analysed the 87 Cochrane hepato-biliary reviews dealing with therapeutic topics posted in the Cochrane Database of Systematic Reviews through December 2008, which we classified according to four characteristics: empty reviews; outdated reviews; content of reviews; implications for practice.
Results
Six empty reviews found no eligible randomised trials and six found one trial, precluding a systematic review; some empty reviews investigated irrelevant topics. Twenty-one reviews investigated outdated interventions, and thirteen of them were posted ten or more years after the publication of the most recent trial included. Most reviews were too lengthy (median: 40 pages) and their consultation was time-consuming with respect to clinical content. They generally compared two treatments, disregarding other options, and usually did not report any non-randomised (although convincing) evidence of potential use in clinical decision-making.
Conclusions
If generalized to the entire Cochrane Database of Systematic Reviews, these characteristics may largely explain why physicians undervalue the Cochrane reviews as a source of evidence for clinical decision-making.
ABSTRACT